2021-10-28 00:00:00 - Joint Committee on Public Health
2021-10-28 00:00:00 - Joint Committee on Public Health
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Mhm So friends, good morning, my name is joe Comerford forward. You are warmly welcome to the joint committee on Public health. Our hearing today though. Virtual is nonetheless important as we're considering bills on patient safety and quality health equity and pharmacy related issues. I am formerly bringing the committee to order. Um It is my distinct pleasure to chair this joint committee on the senate side with chair marjorie Decker from the city of Cambridge, I'm very, very glad to have chair Decker as the co chair of this important committee. I'm going to welcome the senate committee members. Vice chair Senator Susan Moran and senators, Harriette Chandler becca Rausch Julian seer and Patrick O'Connor Um and please on behalf of chair Decker please let me welcome Vice chair representative brian Murray and representatives paul Schmidt, Jack Patrick, Lewis um Representative Vargas Santiago Ashe Khan Howard Kane and Dooley Um There are many many strikingly committed representatives on the call and I'm I'm honored to represent to welcome you on behalf of chair Decker Um Today again We're going to hear testimony on 24 bills and they're in two large buckets, patient safety and quality and health equity along with some pharmacy related bills that were not heard earlier in the session. These are really important bills that deal with critical policy issues facing the commonwealth. Before we proceed formally. I want to remind everyone, please do your best to meet your teams up during the hearing if you're not speaking will help you if you forget but it's always good to do that um colleagues who are on the Zoom or the teams. Of course. I'd love to uh to recognize you for questions or comments after each individual speaker or panel. And I'll do my best to tell you when there is a panel and we'll take questions or comments at the end of that panel. I'm going to look for raised hands. But in the event event that I miss someone, please do feel free to jump in and on mute and ask your question or make your comment for those testifying today. Please do limit your testimony to no more than three minutes. You're going to hear a gentle beep or a chime or perhaps I'll pipe up. Yeah if so. Uh those are not always delicate moments of when we interrupt you. You'll forgive us but it's in the name of Equity so that we can hear everyone in a timely way. If you're testifying as part of a panel, you've been told that your full panels testimony is no more than six minutes. Um So if two people that's three minutes each. If it's three people that's two minutes each and we'll test well time the panels. So it's your job to make sure that you're ordering your testimony in ways that allow everybody there full time. Thank you so much to L. I. S and our staff, public health fellows and interns all doing the work to make sure today runs well. If there is additional written testimony that you'd like the committee to consider. Oh we love it. Please submitted by email the instructions are on the hearing notice on the M. A. Legislature dot gov website for the public Health Committee And under that hearing tab it is the custom of this committee to let legislators testify out of order. That's because they have their own hearings to chair or they are going to testify on others of their bills and other hearings happen. I'm going to try to give people advance notice ahead of time so that you can have some time to prepare. Please on mute yourself only when it's your turn to speak. Um following your testimony, please do leave the team's site. That's what you're on right now. You of course can follow the hearing on the livestream on the M. A. Legislature dot gov site. This is just simply going to reduce the load on the team's platform and help facilitate the hearing.
[SEN COMERFORD:] So we're going to start with members of the legislature. Uh and it is my honor to welcome representative Liz Miranda. Um Miranda is speaking to H 2373 an act establishing health equity at all levels in government. Um Well, warm, welcome to representative.
[REP MIRANDA:]285 [HB2372] [SB1388] Good morning everyone. Good morning. Especially the chairwoman. Decker and Chairwoman Comerford and289 the members of the committee for making space for me today. Thank you to all of you that are here to295 listen to testify and learn and thank you for taking me out of turn for those of you who don't know me. I'm rep Liz Miranda and I serve the mighty and resilient fit Suffolk district, which includes neighborhoods of Roxbury and Dorchester here in boston we know that health disparities have310 continued to worsen across the commonwealth And313 become abundantly apparent to all. During the COVID-19 pandemic. This did not happen overnight and our communities have been battling multiple social and economic pandemics for decades. The life expectancy of black people have dropped has dropped 2.7 years throughout the covid pandemic compared to 0.8 years for non hispanic white people. This is at a moment when people in my neighborhood have already have a life expectancy nearly 30 years less than neighborhoods. Only a few miles away, Black women are more than three times as likely to suffer a maternal death than white women.
Black Americans are twice as likely as white Americans to die from heart disease and we are 50% more likely to have high blood pressure. There is also a large gap in asthma prevalence among black and latino communities which is influenced by factors such as air quality. It is because of these alarming statistics that I'm here today to speak in favour of legislation. I filed with my Senate co filers champion, Senator joe Comerford, age 2373 Senate 13 88 An act establishing health equity at all levels and government also known as the hell healing act. Health equity and the healing act centers, poverty discrimination and lack of access to amenities such as fair pay, quality education, healthcare and so much more as core tenants of how we imagine health critical, all critical in our path forward. This bill will recognize racism as a public health crisis and will establish long term efforts to promote health equity across the commonwealth. It will establish a new government tutorial gubernatorial, sorry, health equity at all levels of government mandate to highlight community perspectives and people with expertise and health equity efforts.
This will be utilized as a resource for the executive and legislative branches to learn about and support future financial and policy decisions as well as how they may affect massachusetts residents differently. In closing this legislation provides the legislature with the tools it needs to examine the bills unintended consequences and potential risk factors. Before it is passed into law. This will be done using a health equity assessment developed by academic partners and those most impacted by health inequities. We need to re envision health equity at every level of government. And this legislation would build a new government wide culture that allows us to move towards are more equitable future. Thank you all we know that solutions must come from all levels of government. We cannot afford to wait around and hope for the best hope for the best it is time to actually start healing. Thank you again for your time and thank you chair women and I will be submitting more extensive testimony. Thank479 you all.
[COMERFORD:] Thank you so much. Representative, I am so proud to hold this bill with you um and to listen to your beautiful testimony and thank you for your leadership on this issue and so much else in the legislature. Um I would just add492 friends that the deans of the five schools of public health in the commonwealth are today endorsing this bill. They see the imperative of this, They see the imperative of asking the question what would happen in the commonwealth if we looked at every piece of policy through the lens of whether it helped or hurt racial health equity and if it helped we'd lean in and if it hurt we take a step back and reconsider the ramifications. So thank you again.
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Representative questions or comments from the committee.
I see none. So530 thank you again Representative um and we look forward to your written comments.
[COMERFORD:] Uh Next up I have the privilege of welcoming senator john keenan the senators here to speak. I understand541 on H 437 an act relative to special pharmacy pilot program for urology and also s 249 to build the senator filed an act relative to collaborative drug therapy management for optimization. Welcome Senator.
[SEN KEENAN:] [SB2492] [HB4109] Thank thank you madam Chair and thank you uh as well. Chair Decker for for holding the hearing today and given the opportunity to speak565 I'd like to focus my comments today mainly on Senate bill 2492 which is an act relative to drug therapy management optimization. Um Thanks and also I want to acknowledge and thank you to578 offer thanks to579 Representative Barbara for filing the companion legislation which is house for 109 right now. General laws um as a588 stand regarding collaborative drug therapy management or C.591 D. T. M. Requires on site supervision by an attending physician in an inventory care clinics but not in other settings hospital hospital community pharmacy. So the practice of physicians and pharmacists working together in the best interest of their patients is somewhat bifurcated. There are607 things that they can do in one setting that they can't do610 any other.
But C. D. T. M. Does require on site supervision by attending physician inserting in certain settings. And during the public health emergency multiple massachusetts providers transitioned C. D. T. M. To remote in order to provide the services, the consultation and the supervision by way of video, audio and secure message. So they made that transition given the circumstances related to the pandemic and the organizations that did this. They amended their internal policies to reflect the availability of and the protocol for remote supervision and it included the ability of clinical pharmacist to reach attending physicians immediately by phone by video or messaging during the pandemic. So they reacted quickly. They transitioned quickly the care provided to patients was uninterrupted and they were able to do that by doing it remotely again with phone, video or messaging. And then following the transition they observed that neither the pharmacist reported delays in reaching supervisory physicians and they reported also that they did not experience any adverse events or safety concerns regarding the drug therapy management from clinicians, patients staff pharmacists.
In other words it worked. Excuse me. So whether physicians are in physician supervision on site or remote uh It's been shown that the care is equivalent in quality. So allowing remote C. D. T. M. To continue by updating the statute will increase the availability of these services and ultimately avoid unnecessary E. G visits that increase health care costs in out of pocket patients expenses. This is a case where we have a practice that has developed and has been proven effective and the legislation has not caught up. And so the purpose of this bill is to catch the legislation up to the best practice and allow this uh the practice the C. D. T. M. To continue remotely. So I reflect respectfully request that you give 2492 a favorable report. I thank you again for listening to my testimony and I am available now or after the hearing to answer any questions. Thank you.
[COMERFORD:] Thank you Senator Keenan I always appreciate your expertise at hearings. Um Senator when we743 were digging in to look at this good bill we looked at case studies like in the state of new york. And is it your understanding um in these case studies that uh CDTM has been shown to improve patient outcomes, improved757 medication adherence and overall decrease the cost of health care. And that's what we're seeing.
[KEENAN:] Yeah, that is true. And it goes to a point where when people don't have access to their needed medication, if they don't have regular access to it, if that access is in any way interrupted, we know that the default is they don't take that medication and that is what leads to them going to the emergency departments as a result of you know, some change in their medical condition because they haven't taken the medication because789 they haven't had access to it. And so we still know that many people have difficulties getting to their physicians offices. We know that pharmacists and physicians are being pulled798 in so many different ways but this800 has shown that if there is this connection between pharmacists and physicians and it really works to the best interests of the best medical health of the patient. So, so yes, it's showing that and813 we think it's a practice that814 should be continued. And it's interesting because oftentimes we do pilot programs before we move to pass legislation, the pandemic has been the pilot and it has shown that this practice worked very effectively remotely.
[COMERFORD:] Thank you compelling pandemic830 as pilot um brutal but true questions from the committee or comments. I see. None. Senator. So thank you so much to you and very much have a great day. Thank you take care. All right friends moving on. Um we're very lucky to have848 so many folks from the legislature here to testify. I want to now recognize representative dr tammy Gouveia um rep Gouveia speaking on H 2309 and act to advance health and well being for all massachusetts residents welcome Gouveia
[REP GOUVEIA:] [HB2039] Great thank you so much madam Chair thank you to you uh to chair Decker as well as members of the committee for the opportunity to speak out of turn. I'll try to be brief because I know there's a lot going on today. I am here to speak to H2309 an880 act to advance health and well being for all massachusetts residents. It is legislation that I filed last session but I did add an additional component that I'd like to highlight that I added in this889 session. Um so we know as was already noted892 by our dear colleague rep Liz Miranda, that health outcomes for black brown neighbors in particular. So starkly different from health outcomes for our white residents and our upper middle income residents as well. And so I filed this legislation to address some of these issues because I see a need At all levels of government as was already noted um for us to address health inequities but also climate justice and climate justice is the piece that I added to the legislation for this session.
Um we know that so many of our residents were suffering already before the pandemic. There was a study done in 2017 That indicated that almost 40% of our residents here in our state are truly struggling And 3% are suffering. We know that the pandemic has wreaked havoc on everybody's health and wellness. Um and so we know that these numbers of suffering and people not thriving, are even worse than they were before. And so this legislation will direct the secretariats under the administration954 to develop and implement plans, um to contribute to mitigating climate change, um and also to ensure that equitable health963 is at the center of the ways that they are making decisions. Um We want through this legislation for the secretariat to identify improvement needs and equity gaps relevant to the mission of their executive office. I often tell that oftentimes tell the story when I was first running for office, people would ask me, why am I leaving public health to go into the Legislature? And I would often retort and say, well, the legislature is where I will be doing my public health practice because I believe that every single piece of legislation um for the most part impacts the health and well being of residents in our state.
And I think it's important that the secretariat's also understand what role they have when it comes to their mission and their practices, their policies, their programs and their expenditures to support the health and well being of all of our residents. Whether you're talking about transportation, if you have a transportation system, that is not people putting people at the centre, then we know that we will have extensive gaps and that those burdens will be particularly fierce for our black and brown neighbors throughout the commonwealth if we have jobs that are not focused on generating wealth and providing meaningful work that that disproportionately impacts are black and brown neighbors. So making sure that secretariats have a role in addressing health equities is the center point of this piece of legislation and also climate justice as well. I know that last session, we are also proud of the environmental justice components that were added to the next gen climate bill.
I think there's more for us to do to make sure that every single secretariat is doing all that they can within their purview to address the climate crisis that's already here. And that has disproportionately been impacting residents in our gateway cities are black, brown and immigrant population. So I1066 just thank you for the opportunity to testify in support of this piece of legislation. It's possible that it's a nice companion piece to your your legislation madam chair with rep Liz Miranda.1076 I look forward to answering questions and also to uh working to advance these pieces of legislation moving forward. So I thank, you all.
[COMERFORD:] Thank you Representative so much for your testimony and your expertise that you bring to the legislature. I do I think of these as sisters actually there in the same spirit of to center public health, climate justice um and equity in all of our policies questions from our colleagues. SHOW NON-ESSENTIAL DIALOGUE
Okay seeing none on this busy day I'll thank you people to talk to us. Well everybody take good care I'm looking now please for Representative Khan who I don't see at first but I want to make sure that the representative isn't here perhaps with camera off.
Okay we will get the representative um in the queue when she comes back and now I'm looking for Representative linda Dean Campbell the house has a particularly brutally busy today today so I don't see at first representative linda di in Campbell same with the representative, we will warmly welcome her um when she is able to come with us. Um now I have the pleasure of welcoming and I think I think senator Feeney and representative McMurtry are going to testify1157 with colleagues but um Senator Feeney and representative McMurtry are here to speak on an act relative to specialty pharmacy pilot program for urology and you have constituents with you. I believe
we do madam Chair. Thank you and I think if McMurtry is on um we think he's batting leadoff for us today if that's okay with you madam chair everything's good and I see the Representative thank you Representative so much for joining.
[REP MCMURTRY:] [HB437] Good morning madam Chair. Thank you. Senator1194 Chair. Comerford chair. Decker members of the committee. I do appreciate this opportunity to testify out of turn and I want to just Comment on the offset. I want to thank you for your steadfast leadership on this committee as we continue to navigate these uncertain times and I'm pleased to offer some brief testimony today and house 437 and act relative to specialty pharmacy pilot programs for urology. And the basis of this legislation is to establish a pilot program allowing for certain doctors to prescribe specific medications which can help achieve two major goals, lower prescription drug costs and more importantly to improve the quality of life for people by cultivating wraparound health care services. You as our cheers and your committee as well as us in the legislature and all of the leaders across state government have made quality health care a priority and that this is yet another opportunity to do just that.
So I believe this pilot program is a step in the right direction at the right time. Massachusetts is currently one of only seven states that prevents doctors from dispensing medications to their patients. And this antiquated1266 law creates barriers for patients to get the health care services they deserve and the ability in many cases to buy prescription drugs or less. An unintended result is that patients on fixed incomes, especially our seniors are being forced to make decisions, including many times traveling out of state that they should not have to and decision to prioritize whether buying1289 groceries and build heating bills are filling their prescriptions. Currently Medicare and many health insurance plans do not cover prescription related to men's sexual health. As a result, the national big box store pharmacies can charge whatever they want for these medications and they1305 do just that. The high cost of these drugs oftentimes prohibits many people from filling their prescriptions and therefore impacting their quality of life. Has 437 will establish a pilot program for four years and provide the data to the Department of Public Health and to the board of Pharmacy to evaluate the overall success of the program for private practice.
Urologists like the those in the district that both senator Feeney and I serve. They have excellent relations relationships with their patients and this will enable them to provide the confidential advice and proper guidance to their patients while at the same time the ability to dispense the appropriate medications that are cost more affordable um in closing and it's worth repeating that although massachusetts is a national leader on many fronts across the healthcare spectrum will get just one of seven states that do not allow doctors to dispense medication. And again, I want to thank you, Chair Comerford as well as my colleague in the house. Decker for your excellent work on this committee. I know you also have a busy schedule as well and thank you for1375 the opportunity to be here and I respectfully ask for your favorable vote and it's now my pleasure to turn it over to a dear colleague and friend. Senator phoenix,
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thank you so much. Representative welcome Senator Feeney
[SEN FEENEY:] [HB437] [SB1436] Well thank you chair comment food to members of the committee and of course your staff uh I know do incredible work day in and day out, inventing many bills in triaging all the issues that we've been dealing1404 with throughout this pandemic. So thank you especially to them and thank you my colleague Representative McMurtry who just articulated very well the need uh for the passage of this bill H 437 which was filed by myself and Representative McMurtry as well as bills Senate bill 14 36 which was discharged I'm sorry was heard by this committee. Initially this bill that we're talking about today was sent to another committee of jurisdiction and discharge over. So I just want to take a couple minutes and and focus most of my remarks on this bill and the reason for this and1438 we just heard from McMurtry about the importance of it and I want to double up on that this legislation as the representative said really has the potential to lower prescription drug prices and to improve the quality of health care by getting vulnerable patients access to the prescription drugs they not only need but are entitled to directly from their prescribing position, madam chair members of the committee were Sena problem unfold here in massachusetts.
And I know you've heard about this before. I know there's other legislation that's been considered session after session about um you know, dispensing prescriptions directly from the prescribing doctor. We're taking a little bit of a scalpel approach to this to create a pilot program to measure it to study it and really understand that this is the best practice in the industry. The fact that medical doctors are prohibited from dispensing pharmaceutical drugs to their patients creates a number of barriers for those patients which this bill seeks to overcome. On one hand, as the representative pointed out, you have national chains, television retailers targeting all sorts of urology medicines direct to consumer, specifically erectile dysfunction or E. D. Drugs. Uh1508 to men all of this is happening on tv on the internet, on the radio. I happen to be somebody who enjoys listening to sports radio most days uh to hear about what's going on in the world of the patriots and the Celtics and you can't go five minutes without hearing a national ad for E. D. Drugs. All of that is happening outside of the care1528 of the doctor's office. Well that's a very lucrative practice for those national chains and corporations.
It's not very good for the patient who should be receiving properly diagnosed medicine from a massachusetts license and board certified urologist. Meanwhile you need to think about the cancer patients such as those suffering from prostate cancer or under the care1550 of of a urologist, prescribes1552 certain medications and then forced to use a specialty pharmacy because of the massachusetts ban on direct access to prescriptions from the, from their urologist. This raises often unnecessary barriers. Excuse me from transportation and cost. And often this um, would would be a barrier towards compliance for that patient with no cost madam chair to the state and the potential to provide a better quality of life for patients and lower drug costs. I believe this legislation in the form of a pilot could just help lower those barriers. It is narrowly tailored to have the most direct and pinpointed impact and it is appropriately scalable so that positive results can be repeated in the future.
All while following the current regulations on the books for the safe operation of health care facilities in the commonwealth. And I just want to talk for just a quick minute about the nitty gritty of how we're going to accomplish this. First. This 4-year pilot program would be overseen by the Massachusetts Department of Public Health. The Massachusetts Board of Pharmacy. It would be open to the 1st 10 private practice urologists that have five doctors or three offices. So what we looked at is, you know, are there established private practices here in massachusetts that have been in compliance with the current regulations that could take part in this in this program. The selected urology practices would comply with massachusetts laws regulations of course. And reporting just like every other registered pharmacy here in massachusetts, they would hire a pharmacist pharmacy tech to run the pharmacy. In addition to urology practices would be limited to dispensing pharmaceuticals to the scope of their practice. And this is very important, the scope of the practice of urology and that's it.
As we limit them in this bill, only patients of the selected urology practices would be able1655 to use the pharmacy within that practice. We also prohibit opioids from being dispensed in this pilot program to avoid any indication conflict with furthering the opioid crisis, madam Chan So we really believe this could lower costs. It would increase uh improve the quality of life, it would increase compliance. Um and you know, really it's, this is something that I think is long overdue here in the commonwealth massachusetts. We were thoughtful and trying to establish this as a pilot program so that we can measure it, have reports back to us and understand. Mhm. You know, if they should be scalable in the future, we should be thinking about this in terms of convenience, cost and compliance. So I thank you madam Chair members of the committee for the opportunity to testify. I'm excited to hear from doctor Kerans who is a constituent of mine to talk about his experience on the ground and the patients that he cares for and why this would benefit them. Thank you, madam, Chair
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senator. Thank you so much for your passionate testimony, Senator and representative. I'm happy to take the physicians now. Should we consider you all a panel and then hold for comments and questions afterwards if that works for your schedules
and again I know everybody's in and out today because it's a nutty Day Happy to do that. Okay representative, does that work for you?
It does, thank you senator. Okay very very good. So we will move on then and and again welcome uh dr Michael Curran um uh on H437
and also I'm looking at for your s 1435 dr Curran.
MICHAEL CURRAN:] [HB437] [SB1435] So good morning chairwoman Decker Chairwoman Comerford and thank you for taking the time to hear this. Um My name is Dr Michael Current and the president and ceo of greater boston. Urology were a private practice group of 17 urologist We1779 have nine offices that spanned from Cape cod to Boston to framing him for the largest private practice group of urologists in the state. We have over 100 employees. We see over 43,000 patients annually. Um we actually deliver approximately 20-25% of all the urology care in the1797 Commonwealth. We also support and provide full urology services. Too many of our local hospitals where practices are located, Falmouth Hospital, Cape Cod Hospital. Good samaritan hospital, Norwood hospital. Milton Hospital, Metro West Medical Center, Kearney Medical Center. And we have now also added women's health and Euro gynecology under the directorship Abductor Angel Murray johnson. So with this were able to provide our patients with what we believe is1830 the best care and at the lowest cost in the commonwealth.
Our patients typically are older, the average age of our patients is in the lower 70s and we believe it's important to provide comprehensive wraparound health care for our patients. We have several barriers in doing this. one. Such barrier is our inability to dispense the medications directly to our patients that they need. As you've heard, Massachusetts is one of seven states in the country that lets doctors write prescriptions for pharmaceuticals but does not let doctors dispense those same drugs. And it should be pointed out that we're talking1864 about oral medications. If the medications to be delivered, intravenously intramuscular or subcutaneous Lee were allowed to dispense those drugs in our office. But if the medication happens to be delivered in an oral form, we simply aren't allowed to do to the legislation that's in place in the commonwealth. We believe this is an antiquated law and it creates an extra unnecessary burden on the patient.
And we're now going to national corporate uh drugstore chains to receive their medication as well as what's been mentioned, um Internet based practices where it's unclear whether the patient is actually seeing a Urologist physician's assistant, a nurse practitioner, a person that may be prescribing the medication may actually have no expertise in urology or even erectile dysfunction until the day.1915 They were hired by the, the national organization that has this web based service. Um, so this causes many issues, especially around erectile dysfunction drugs. This is a stigmatizing condition that many men suffer from. Women suffer from it as well. And there's in the future going to be um oral medications to help treat uh female sexual dysfunction as well. But many of these patients are embarrassed and they don't want to go to their local um Fox chain store and they may have the prescription being filled by a pharmacy tech that they coached in Little League or that's their neighbor and therefore they tend to either not fill the prescription or they fill it at a pharmacy two towns over and that's just an unnecessary burden to place on this population.
So we actually see approximately 20% of the patients that come in requesting um sexual medications and help with erectile dysfunction where their prescriptions will go unfilled. And the primary reason is that they just don't want to face the stigma of picking up the prescription at the drugstore. 2nd barrier, these patients1990 faces cost most of these medications are not covered by prescription plans. They're not covered by Medicare, They're not covered by mass health. So there are there discounts that they can get through their traditional health insurance don't exist on these drugs, which allows the box store to really set a price arbitrarily they will really set the price at whatever the public will pay. And they tend to charge for just 11 dose of Viagra could be anywhere from 15 to $25 and we can provide that medication at a much less expensive rate for the for the patient. Um Dr Karen forgive me. We did hear a bell um and I'll remind everyone that we have this three minute requests2038 that we can hear all testimony today. I was summing up anyway, here we go. So basically it's just this is a bill to provide better access and enhance privacy and uh the other thing about it is it really will have a zero cost to the state.
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Thank you so much for your testimony very much appreciate it. Um And thanks everyone for your patience with this three minute request um uh questions or comments from the committee.
[COMERFORD:] Okay I have just two quick ones. Um The first actually and you'll forgive me here. I don't have, I'm building, I don't have currently but I'm trying to build some expertise with the field of urology. One of the pieces of critique that we've heard about this idea and I hear what you're saying in terms of cost and access and privacy and equity. I hear all of those uh pieces from all of your testimony. We've heard some concern that some of the drugs listed in the pilot are actually related to treatment for cancer. And these drugs themselves are um you know quite intense and they have reactions with other kinds of medication that are fairly complicated. And so the question is especially perhaps for dr curren um you know, is the field of urology. Are you as a urologist um you know at a point of practice where um these drugs often prescribed by oncologists would be those that you could monitor effectively and think about reactions um and relationships to other um other medications.
[CURRAN:] So typically with the2148 prostate cancer patient, the specialty2150 pharmacy section of the bill were dealing with drugs that are typically prescribed by the urologist, not by the oncologist for the prostate cancer patients. They're usually not seeing the oncologist until chemotherapy is is in the um in the treatment paradigm for that patient. So there's a lot of these oral based prostate cancer medications that are required to go through specialty pharmacy and those are the you know the urologist typically is the doctor that is prescribing and managing those medications for the patient and on the specially pharmacy side of it you're taking, you know what are as you mentioned,2188 very potent significant drugs that have a pretty long list of side effects. And when they go through specialty pharmacy it really is a situation where the patient2199 never actually sees the pharmacist. Unlike when you pick up your prescription at the at the local drugstore, especially pharmacy is something that's usually mailed out to the patient.
There's a lot of paperwork in the background for prior authorizations, et cetera to make sure that the prescriptions are approved by the insurance and the patient has insurance coverage. So we already are required to do the legwork on the billing side of it. We do the management of the medication. Um The patients because of the mechanism especially pharmacy never really see or talk to the Pharmacists are given an 800 number until they can call that. So what the patient typically will do is come back to to us is the prescribing physician either at the appointment or they'll call us on the phone because they have a relationship with us and ask us about side effects and interactions with medications. So we're really doing everything2258 except the physical act of handing the patient the medication. And and but to answer your question specifically. Yes. These are medications that are typically prescribed and managed by the urologist.
[COMERFORD:] That's helpful information. And in that would I then could I then presume that as the urologist prescribing these medications you would have access to the drugs, the other drugs potentially that your patients are taking so that you would look for negative interactions.
[CURRAN:] Yes. And that's that's why with this pilot program we've said that we would have a pharmacist on staff and a pharmacy tech and with that there's um there's software that's readily available in2303 every pharmacy has access to that2307 will scan for all active prescriptions that that patient2310 has. You you run the match on the computer to see2313 if there's any interactions so that you can2316 pick up those things. And then when we see the patients we also go over their non prescription medications. Are they on an anti histamine? Did they take vitamins et cetera
[COMERFORD:] extremely helpful.2329 Thank you. And then there's a second question I had about this pilot. I appreciate you setting it up as a pilot. And I wondered and perhaps even the senator and the representative would want to jump in here as well. Um I wonder about2341 the potential impact on other specialties medical specialties who also prescribed medication but don't dispense medication and and how you could see this um being a useful tool for learning about those specialties and of course dr current if you want to jump in as well. That's terrific.
[CURRAN:] Sure. I'll jump in. You know, I think that the real issue2366 that we're dealing with is that patients have many sources today where they can get their pharmaceuticals. But the most common avenue is where the patient is going to get the lowest2376 cost and and I think that's just a practical consideration. So the patients going2381 to be looking for um discounts that come through prescription drug insurance2387 plans. So as as we deal with the patients in the office, we're dealing with their their global situation, you know, their social situation, their economic situation as well as their medical situation and many, many pharmaceuticals today are more and more becoming not covered or they're at a higher tier. And if we have the ability because the neurology and the pilot program, we have the ability with practices in other states through group purchasing organizations to sometimes acquire the wholesale medications at a at a lower cost added in a much less of a markup on the prescription.
That can allow the patient another competitive place to shop for2434 their pharmaceutical services. If the patient's insurance plan covers it at a at a very reasonable rate, then by all means they'll be going to the the local pharmacy. But the real2446 issue is do we, do we really want health care system where patients have to go to four or five different2453 locations to get their care greater boston Urology, we've been trying to develop a vertically integrated plan that kind of wraps our arms around the patient on all aspects of their care. So we try to get everything done at one location with one trip and that provides a tremendous advantage and efficiency in the delivery of care. And it also prevents redundancies in the system
[FEENEY:] madam Chair, if I could just to echo dr Kerans uh comments there and to answer your question a little bit and I think that's exactly why, you know, we see this as such a positive. Um you know, uh move forward to say we can actually study, we can see how it works in this one particular specialty and then scale this to other additional specialties. I mean, you know, health care especially over the last year and a half, you know, all too well has been turned upside down. I mean look at look at what we're doing with telehealth. You know, we're starting to change the way that health care is delivered uh for patients in the commonwealth. And you know, I think a lot of that is positive when we look at the pharmacy centric model that has existed for years and years and years, largely due to some protectionism.
And we know that um you know, that's starting to be turned on its head uh as well where folks aren't, you know, they're not going to their local family owned pharmacy in the downtown anymore where they have a relationship. Um they were able to pick up the phone jump online, you know, meet consult with a doctor, quote unquote dr that is,2544 you know, an upstate new york somewhere and then get prescriptions mailed to them. Um that's happening organically and you know, in addition to that, when I look at your folks in our district, especially those that are elderly and have certain challenges in getting to their appointments anyways. You know, I looked at my own district and said, you know, many of the seniors in my district rely on as in the odds, relying regional transportation, you2570 know, many of them now trying to figure out Uber to get to the to the different appointments.
Well imagine they have to go, you know, they have this on their schedule, they go to their appointment at the urologist or another specialty clinic that they have to go to. Perhaps they have to go see their primary care physician on the same day. Now2586 they're given prescriptions and then they have to go to a pharmacy um which causes you know, an additional burden trying to get to it. And we've seen in effect compliance for that patient and oftentimes they just don't feel the medication. Um So I think, you know, when you look at other specialties, when we look at kind of the whole the whole picture, I think this is a positive, we can measure it, we can see how it works, make sure that there are controls in place and then scale it up to additional specialties uh in the future.
[COMERFORD:] Thank you so much, Senator, I2620 really appreciate that. Um I do believe that Senator keenan also wanted to jump in on this and Senator, you were so brief and your other testimony um that I'd love you to jump in on this bill as well.2633
[KEENAN:] Thank you. Thank you2635 madam Chair. And just to give a very quick personal perspective on this, I have been dealing with prostate cancer2641 for the last 14 months and everything that Senator feeney represented McMurtry and particularly dr current has said is absolutely true it to be able to access these medications directly through the urologist office would be enormously helpful. There is no substitute for that relationship between a cancer patient and physician. The relationship that's developed from first diagnosis through treatment and uh the idea of having to pick up the phone to call a remote physician in order to get a medication from a compounding pharmacy or some other pharmacy. Um It's just I think there's a lot of downside to that.
There is no substitute for the physician patient personal relationship and getting the information patient needs directly from their treating physician and then to have the ability once that is done to get the necessary medications right from the treating physician I think is is the way to go. And certainly the way uh something to explore through a pilot program every time a patient leaves in office it has to go elsewhere for the next part of necessary care is an opportunity being presented for the patient to fall out of treatment and so being able to have everything in the physician's office, particularly in this area that they're talking about. I think it is critically important and that somebody SHOW NON-ESSENTIAL DIALOGUE
I lost Senator Keenan I don't know whether it's me, is it just me? Yeah, I see, I see people shaking their heads. Okay. No, it's not just you, we all lost him. Thank you. Senator Rausch um uh for your vigilance? Um well hope that Senator keenan unfreezes but mindful of everybody's time. Are there questions or comments from the committee?
Okay, I see none. I will say this has been very compelling. I had questions coming in and I'm deeply grateful for your expertise. Representative McMurtry Senator Feeney and of course dr Curran um with that, I'll conclude this conversation. I hope Senator keenan is um well if the unfreezes we'll hear him even if the end freezes2781 in the middle of something else. Um So thank you all so much and we'll move on thank you. Um uh so uh we're now going to transition to public testimony. Thank you for your patience as we've heard legislators out of turn, I'll just respectfully remind everyone that you're going to hear that buzzer at three minutes um and2805 then we'll just ask you to wrap up if you haven't already. Um we may see legislators pop in again there on the floor today, especially in the house. It's a brutal time in the House2814 today, just super busy.
Um so next we're going to hear from Lynne Hancock um and Lynn is speaking on h 2339 filed by representative Khan and act establishing a commission on quality patient outcomes2829 and professional nursing practice Lynn you're warmly welcome,
[LYNNE HANCOCK (ANAMASS):] [HB2339] [SB1527] thank you. Good morning, thank you. Senator2838 Comerford and the committee for allowing me to present testimony today on behalf of the american nurses association of massachusetts a in a masses to premier volunteer professional organization representing and advocating on behalf of the interests of the commonwealth. 140,000 plus licensed registered nurses from all rules and practice settings. My name is Lynn2858 Hancock, I'm also a registered nurse and president of A and a mass in the magnet program director for boston Children's Hospital and a mass will be providing written testimony as well. Today I'm testifying in support and urging the massachusetts Legislature Legislature sorry to support and pass. H B 23 39 S p 15 27 act establishing a commission on quality patient outcomes of professional nursing practice. Over 70% of the voters in this Commonwealth voted against the ballot initiative in 2018, which would have resulted in mandated nurse patient ratios in acute care hospitals.
What was learned from that mess was that Massachusetts citizens recognize that a one size fits all nurse patient staffing solution does not necessarily work. Recent experience in the early days of COVID-19 pandemic illustrated the critical role of nurses and providing life saving care to the most seriously ill patients affected by the virus nurses and health care facilities responded to this challenge is a challenge in various ways, including innovative and flexible ways to match nurse skills and patient needs. For example, one institution in neighboring Connecticut created color coded teams based on our own experience and credentials, patients receive the needed care and nurses were able to provide that care best aligned with their experience and expertise. This example demonstrates how collaborative staffing decisions can take into account the numerous variables associated with providing care, establishing a commission on quality patient outcomes2944 and professional nursing practice. To examine evidence based staffing principles into review and make staffing recommendations would be the best way to actualize the Institute of Medicine's future of Nursing.
Key recommendations that nurses should practice to the full extent of their education and experience and be full partners in redesigning health care. Nursing care is complex and multifaceted and the solution is not simply as simple as increasing the numbers of nurses, dynamic and nimble processes and solutions are needed, especially considering the current and future nurse shortage. A mass believes that other states states legislative experience and potential regulatory solutions may help inform and serve the citizens of the commonwealth. Examples include Illinois, nurses having the voice in determining appropriate staffing levels. The Illinois legislature strengthen the existing nursing care committee's ability to develop staffing plans that requires the hospitals to adapt them or risk fines. A similar bill passed in New York required Hospital Committee be comprised of at least 50% direct care staff in this bill staffing plans, consider each units uniqueness and consider the characteristics of the patient population, census skill mix and other important critical value variables I encourage the legislature to consider.
Also the 2019 H&S principles for nurse staffing which are based on evidence that demonstrates the link between appropriate are staffing and better patient outcomes. The core components include but are not limited to the RNC are full partners in the delivery of care. All settings should have staffing guidelines accompanied by measurable nurse sensitive indicators. All our all our ends have an active role in staffing decisions. All nurses and patient characteristics must be considered in reimbursement structures should not3047 influence staffing patterns um or patient care and we'll include these standards in the entirety with a written testimony and I'll just wrap up due to the current pending3056 nursing shortage establishing the Commission on quality patient outcomes and professional nursing practice of is of utmost importance and should be passed during this legislative session. Thank you in your thank you for your time and consideration to this critical matter and I'm happy to answer any questions you might have.
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President Hancock thank you so much and thanks for your service. Um and3076 that of your members. It's been critical on the front lines work saving lives and we're deeply grateful. Uh all you do questions from the committee.
Okay? I see none. Thank you. You outlined the bill perfectly and I'm sure3093 we'll hear from Representative Khan and thank you so much for coming in to make a thank you. All right. Um I see that Representative Arciero has joined by Representative Arciero. You're warmly welcome. I believe you're testifying on H 2219 an act relative to non opioid alternatives and pain treatment.
[REP ARCIERO:] [HB2219] Thank you so much. Chair Comerford and share Decker and members of the joint Committee on Public Health. It certainly is a busy day today. I think we're all multitasking um in myself in room virtual room 3 48 and back and I see a lot of my colleagues here doing the same. But to testify before you today in strong support of House Bill 2 to 19 legislation I filed with several of our colleagues to address the use of non opioid alternatives and pain management. I don't have to tell you of or the committee of the devastating impact3146 that the use of opioids has had on our nation and state. In the last two decades, addiction and death have become all too common as these very dangerous drugs have gone from our hospitals, doctors offices to our streets and vulnerable populations. This legislation simply seeks to have a non opioid alternatives given equal weight to the use of opioids whose strength and addictiveness pose such a risk to some of our citizens. Specifically.
The bill seeks to establish a program to develop and publish an educational pamphlet regarding the use of non opioids as an alternative strategy to deal with the treatment of pain. This information would explain the non opioid medications that are available as well as as non pharmacological therapies that could be utilized by a patient. This critical health care information will allow patients and or their representatives to make informed choices about treatment options, medications and therapies and we'll especially be helpful to those who deemed themselves as being at risk for drug addiction and abuse as members of the Joint Committee on Public Health. You know the countless stories we have heard of individuals suffering from pain who have been given opioids and who have found themselves quickly addicted to the serious and strong forms of medication. This bill seeks to give patients the critical information they need to make informed and safe medical decisions about their care. The right to control one's medical decision is fundamental in our society. And this bill will add to that ability to do so. I asked her favorable consideration of House Bill 2022 19. Thank you very much for your time.
[COMERFORD:] Thank you so much. Representative Arciero for this really important legislation. Um When I first saw the bill I'll just tell you the truth, I thought to myself this isn't common practice like oh my goodness, we have to we should legislate this. Um So I really can't tell you how grateful I am that you're calling attention to the need for this critical change.
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Well, thank you madam Chair for taking me out of turn, please question comments for the representative.
Okay, I see none off to your next thing. Representative. Thank you madam. Chair. Alright, take good care.
[COMERFORD:]3287 Okay, Alright friends um I am going to read a list of folks so you can prepare um and know sort of a little bit more about your timing. First up Liz Friedman speaking on H. 2337. Then dr amy major speaking on two bills H 2219 and S. 14 oh two. Uh Next step Boris Schwarzman speaking on H 2219 which Representative Arciero just spoke on then3316 robert to Serbian, forgive me if I pronounce that wrong, speaking on S. 14 oh two so I'll go back now to Liz warm3325 welcome to Liz Friedman um We welcome your testimony. Oh thank you so much, Chair Comerford can you hear me? We're good to go.
[LIZ FRIEDMAN:] [HB2337] [] Okay good well good morning to you chair, Comerford Chair Decker and members of the committee, thank you for the opportunity to give testimony in support of H 2337. An act establishing a special committee to study the integration of support groups into our health care system filed this session by Representative Kay khan H 2337 would create a commission to allow experts to study how trauma informed evidence based support groups could best be integrated into our current health care system. It's our experience that this would result in lower health care costs and more positive outcomes across the board as this committee knows better than most critical gaps exist in our current health care system that keep it from being properly equipped to support many individuals, mental and physical well being the peer support model is designed to close some of these gaps, ensuring people can be heard in a trauma informed group setting that provides a group mental health care with culturally competent and qualified leaders, especially as we work to emerge from.
The covid pandemic mental health care remains expensive and inaccessible to many3397 due to barriers such as long waiting lists and inadequacy and cultural or language. Support fully 40% of adults reported struggling with mental health or substance use over the past year. That's a double the expected pre pandemic rates and a federal suicide hotline reported an 891% increase in calls in 20 20/20 19. Research has shown that the effective use of support groups can increase positive health outcomes, especially when those groups are trauma informed and follow a replicable successful model. Support groups can help an individual stay on track with a treatment plan to avoid additional prescriptions, possible health emergencies and additional costs to our health care system. I've witnessed these outcomes firsthand since launching GPS in 2017 which is my organization called group here. Support the program has expanded to train group leaders in states across the country and teach professional and peer leaders across massachusetts Beyond Gps. Peer support has been introduced to several organizations across the Commonwealth and has been proven to be incredibly effective so far.
The Department of Public Health's Bureau of Substance and Addiction services has used our model to train addiction specialists since 2019 expanding their care and increasing the evidence based on trauma informed approach. And it has been utilized in support groups for new parents with MCP app, for moms, um, and other kinds of sites like that. We have it in Washington State where it is integrated into DCF services and is supporting3489 Children, youth and families. Um in conclusion, this bill would begin Uh investigation into the most effective way to implement this powerful tool of peer support into our health care system, increasing access to much needed support at a lower cost and supporting patients throughout the Commonwealth, given the benefits of group mental health care, in improving mental health, physical health in the Commonwealth, I respectfully urge you to pass H2337 and refer it positively out of committee and of course I'm happy to answer any questions. Thank you so much.
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Thank you so much for your testimony. I must say I'm also proud3526 to represent you in the Senate and I am proud for you to represent me and I know of your good work on pure support. Many, many do um questions from the committee.
[COMERFORD:] Okay, I will just say, and as you know, Liz this made it very far last session um with favorable reports all the way up the chain. Um, so I think clearly leading with peer support folks with lived experience at the center of any recovery and healing is essential. So thank you so much for coming in and making us smarter once again
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thank you so much. Senator. All right, moving on another person who makes this committee smarter. Dr Amy major speaking on H 2219 and S. 14 oh two.
[AMY MAGER:]3577 [HB2219] [SB1402] [HB2273] [] Thank you. Chairwoman Comerford and Chairwoman Decker Um Senators and representatives of the committee and legislators who are also present. Thank you for the privilege and opportunity to speak before you. Um eight I'm requesting for support for H 2219 with an amendment. The amendment being to add the words evidence based in section one that currently reads information on available non opioid medicinal drugs or drug products and non pharmacological therapies. The american society of acupuncture is has created a document specifically for Mds to learn when and how best to refer to acupuncturist for their patients that's included in my written testimony. Um It's a one page document that cited as is a one page document that cited on acupuncture before opioids because when we decrease the amount of opioids in circulation, then we decrease the amount of addiction on the other end when we address people's pain appropriately, then they need fewer opioids.
The second bill I am here to address with gratitude to Senator. Cyr is S 1402 asking also for it to be reviewed favorably out of committee. I have testified for different versions of this bill many times and versions of reptiles. Bill H 2273, which is about setting appropriate medical standards for the practice of Dry Needling, which the CMS cPT code group owned and administered by the American Medical Association has said are the same thing. So when we have to procedures that are the same procedure and we have licensure for one and zero standards for the other. That is a serious challenge. When we are looking for medical practices that are safe and effective, we want to make sure we have demonstrated that the people providing that procedure have been vetted appropriately.
Currently allied health professionals are vetted for teaching exercises but for nationally but they are not examined nationally for the invasive procedure of inserting needles into patients. There is submitted testimony in writing that also includes a ruling by the Board of Registration in nursing that stated both in 2013 and 2017 that um dry needling is out of scope of practice because it involves the procedure of acupuncture and we need to be able to vet knowledge skills and abilities and decreased consumer confusion. There is profound confusion because patients don't know that it's not in scope by a regulation or legislation for allied health professionals to perform this procedure which is very intense. Um So consumers are confused and they're having their equating licensed acupuncture is with Dry Needling and there's no vetting and this is a problem. So we're asking just as our medical colleagues are asking for um to decrease confusion. Thank you so much for your time.
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No, thank you. Thank you for your time. I'm hearing a little little go.
Okay. Are you hearing hearing? Yes ma'am. Okay.
Just
all right, well done for time. But Can you hear me? 2012. Thank you so much testimony, my colleague.
3810 Okay,3810 I don't see any. I do note your request for amendment. We've captured that in the notes. I appreciate that thoughtful edit will certainly bring it to the attention of the representative who spoke. Um And we'll look for your written testimony which I know will be much more detailed. Uh3828 So good. Take good care. Thank you so much. All right friends. So now we're onto reminder that we're going from boorish Boris Schwarzman to robert. Uh Caribbean. The next on deck are Susan curry. Um trainees, polk, richard Glassman and russell roberts. So going back up to the top of the list. Boris Schwarzman, you're warmly welcome
and I don't see Boris. Okay, perhaps Boris will be with us later. I'm going to go now to robert, robert. I've seen you since the beginning. You're warmly welcome to testify.
Thank you so much. Chairwoman. Can you hear me?
[ROBERT SURABIAN:] [SB1402] All right. Uh Thank you. Co chair senators and representatives for the opportunity to speak. I urge you to support S 14 oh two for one. Very simple reason, trigger point acupuncture and dry. Needling are the exact same thing. The american Medical Association CMS CPT code group, which is the federal group that creates billing codes for all medical procedures. Set this as policy in 2018 is imperative that everybody who utilises this invasive procedure meet meaningful and appropriate training standards. S 1402 sets those standards to protect citizens of the commonwealth from providers who are now practising Dry Needling without adequate training in the current environment. There are medical providers taking weekend certificate program in Dry Needling and telling patients they are certified. This is inherently untrue receiving a certificate for a short program that does not meet any reasonable standard required for every other provider is entirely different from earning a nationally certified certification, claiming otherwise is deceptive and dangerous to the public.
As 1402 rectifies this discrepancy and will protect the public by requiring comparable training standards for those who use dry3950 needling. But are neither medical doctors nor acupuncturists allowing unequal allowing the unequal parallel track to a certificate for the exact same procedure to remain in place any longer is just absurd. The citizens of the commonwealth need your support on this bill to protect their health and safety from providers who without meeting adequate standards are at risk of causing real harm to unsuspecting patients. I want to add that. I have been attending the monthly meetings of the board of allied Health for the past four years where this, where we have tried to engage in a conversation about what adequate, adequate training standards would look like to be stonewalled.
And the, the position of the board is that dry Needling is not acupuncture,4000 which4001 we have already established as it is acupuncture and that it is an advanced technique and individual providers are required to see to their own training and practice at that comfort level and that the board will only get involved if and the board can, they've been told they can only get involved if there is actually a case against a practitioner brought to the board. I would hate to be that person who is the case because the things that bring a case forward are things like a new Moore thorax where there's a puncture of a long where uh, you know, uh administrative assistant who's going to someone to help with carpal tunnel has their median nerve pierced and there's a major damage. There's documentation of these things all in the country and all over the world and it's because some people are practising without adequate training. This bill rectifies that uh, and brings the practitioners who are currently utilizing this invasive procedure uh, into the same standards as everybody else. Thank you.
[COMERFORD:] Thank you so much for your passionate testimony. I appreciate it and your expertise questions on this bill. Okay. Okay. I don't see any. So I'll thank you again for coming before the committee. Um, I'm looking now please for Suzanne curry. Suzanne, are you here? I'm here. Thank you. Chairwoman. Great, perfect. Thank you so much.
[SUZANNE CURRY:] [SB2373] [HB2388] Thank you. Chairwoman Comerford and members of the committee. My name is Susanne curry. I'm the behavioral health policy director at Health care for All and were testifying today in support of House bill 23 73 Senate bill 13 88 and act establishing health equity at all levels of government. The healing act and Chairwoman, thank you for your leadership and championship of this issue. It's much needed. Health care for all advocates for health justice in massachusetts by working to promote health equity and ensure coverage and access for all. Um and we absolutely agree with the points made earlier by Representatives Miranda and Gouveia as to why something like this is needed and to be prioritized in the commonwealth. Um just a few additional things about, you know,4136 we we do recognize that massachusetts of course with the leadership of the legislature and other policymakers working with stakeholders like us, we are a leader in health coverage and care and even health outcomes. But if you scratch the surface, these successes don't reach everyone equally.
Um the heart of our organization is our multi lingual help line which takes over 20,000 calls per year to help residents navigate the healthcare system troubleshoot healthcare issues and we hear every day from consumers who encounter problems with their health coverage4165 or accessing culturally and linguistically responsive services and we also know that black and next families in massachusetts report more challenges paying medical bills, having unmet needs for medical behavioral health or dental care and many chronic conditions disproportionately impact communities of color. And in the maternal health realm is represented Miranda. So eloquently talked about black birding people are much more likely to die or experience serious illness due to pregnancy related causes.
And these are just a few examples of racial and ethnic inequities within the health care system. And of course, health is not just influenced by access to good health insurance or even access to health care. Social determinants of4208 health like housing, food, employment, safe neighborhoods, education. You can go on have such a great influence on health outcomes. And we know that the4217 covid pandemic has clearly exposed health inequities due to deep and persistent structural racism and socioeconomic inequality. This is something that's not new to many of us are news too many of us and especially not news to the families who lived in this every day. Many for generations. So where we really support the healing act, We it names it racism is a public health crisis and it tries to do something about this on a structural level by creating an infrastructure to assess health equity as a core part of the executive and legislative branches in the policy and program development.
And we really are happy to see that the bill also creates a community oversight board to ensure both accountability and that the voices and perspectives from those who are most impacted. Have a voice in the process of assessing health equity. If we really want a more equitable commonwealth, we need to systematically change how policy is made. And this requires creating4274 the culture and the infrastructure that prioritises health equity at all levels and across all sectors4280 of state government. So healthcare for all Is proud to support House Bill 23 73 and Senate Bill 1388 and respectfully requests that the committee reports this bill favorably quickly and brings it to the floor. Thank you.
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Thank you so much Suzanne. Um, and thanks for health care for all you know, all4300 around work. Clearly, I'm grateful for your support of this legislation, but I know you do so much more. Thank you for your support on many, many4309 things questions from the committee.
Okay, seeing none again, thank you so much for coming4317 in. Okay, very good. Take care of Suzanne. Thank you. Take care. Uh, next up we have uh, Sena C polk and I'm very sorry if I got your name incorrectly. You'll correct me Director of racial equity and community engagement boston Public Health Commission. After the speaker. We're going to go to Rick Glasman Russell roberts. Um, and I'll circle back up and catch others who are are here to testify. Uh,4350 you spoke your warmly welcome, please make me smarter and it's pronounced her niece. You are very, very close close enough. That's okay.
[TRINIESE POLK (BPHC):] [HB2400] Um, thank you so much for having me today. Good morning to Comerford chair, Decker and members of the committee again. My name is johnny spoke and I am speaking today on behalf of the boston Public Health Commission, where I am currently serving as the director to the office of Racial equity and Community engagement. And I am here in strong support of age 2400 and have declaring racism or public health crisis which would direct the massachusetts Department of Public Health to make a report and recommendation to the state's Public Health Council as to whether racism should be declared a public health crisis in the4395 commonwealth. The boston Public Health Commission can attest both in our role as public health experts and from our own experience with boston's declaration of racism as a4405 public health prices that a declaration would be a valuable tool to advance racial justice and health equity in the commonwealth.
First, I'd like to be very clear that there is a consensus within public health that racism is a public health crisis. A conclusion that public health experts have come to. After decades of research and analysis. Second, massachusetts would be far from alone in making this kind of declaration as of october 2021 the american public health Association identified more than 200 states and cities that have declared racism of public health crisis, there is evidence that these declarations can have an impact so long as the declaration is paired with an appropriate allocation of resources and strategic plan for action and we know this from experience in boston. In june 2020 then Mayor Walsh declared racism of public health crisis and released $3 million in funding to the boston Public Health Commission for work related to eight um um specific strategies to4465 reduce racial disparities in the city.
And we would like to thank um Mayor kim janie and other leaders across the city government who continue to support this work.4475 We are very grateful for4476 the support and coordination with other city departments including the4480 Health and Human Services Cabinet PHC concentrated first on an equitable community engagement strategy to help inform all of our, all of our work related to the declaration and projects and investments that were undertook were directly informed by those residents who were impacted here in the city. Key highlights of our first year of work included development of the boston health equity measure set a partnership with 11 hospitals and seven community health centers to share data on Health Inequities. A community based translation pilot, an extensive covid 19 health equity survey so that the responses from boston residents of colour can inform BPH.
These covid response And August we issued a year one report on our work and that can be viewed on our website and we are looking very much forward to building to building our work in year two, We support a 2400 because while cities like Boston4539 can be creative laboratory for this kind of work, further action is definitely needed at the state level where large scale decisions about funding can and policy are made. We would also like to briefly highlight another bill. Um that's before you today, age 23 724558 slash S 13 88. The hailing act. So like age 2400. This bill is intended to galvanize an all of government response4567 to the public health crisis of racism that is before us to today. So thank you so much for the opportunity to speak and to provide comments and we hope that you will consider issuing a 2400 a favorable report again. Thank you so much.
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Thank you. Thank you for your work. Thank you for your leadership, your passionate and skilled expertise. We're really grateful. You're leading the way. Thank you so much. Um Very good. Okay moving on. Um we have Rick4602 Glassman please.
[RICK GLASSMAN:] [HB2259] Good morning Senator Comerford and uh Representative Decker members4611 of the committee, thank you for the opportunity to comment. We're here this morning to speak to our concerns and our opposition to House 2259 and act relative to do not resuscitate orders. And uh we are as you might already know the protection advocacy system for the commonwealth. That means under federal law were designated with responsibilities to investigate and monitor for abuse and neglect and advise policymakers and we're here in that capacity this morning. So this bill would ease requirements for D. N. R. Orders in a way that would be a marked departure from existing law essentially. Now uh D. N. R. Orders require court oversight and substituted judgment in all situations. Uh, except those that are deemed to be noncontroversial, which under the case law, at least as I understand, it means the person has a terminal illness that there is no treatment that's available and there is no involvement that already exists through, through the courts or through state agencies.
This legislation would do away with almost all of that and allowed dinars to be uh imposed by a family member or relative who is a guardian um without any requirement of an existing underlying medical problem other than the fact that the person has a guardian and they have difficulty communicating. So in other words, there is no requirement here that the person be terminally ill. There is no requirement that the person have any medical problem at all. And so to bring it to an absurd level, someone could just who is a family member slash guardian could go to a physician's assistant and say that they wanted A. D. N. R. And regardless of the medical condition of the individual, that would have to be followed down the chain4727 by other providers. I don't think that's what the drafters of this bill intended or what proponents of this bill might want. And uh, and we've reached out to rep Campbell who we consider an ally of the disability community.
She she was the lead sponsor in the abuse registry bill, as you might know. Uh, and we have raised our concerns but we wanted to appear today just to voice those concerns with you today. And our position really is that even if you were to include that physical uh illness, terminal illness requirement, we still wouldn't know who's going to make these decisions about whether there's a terminal illness. How is that person going to be qualified? How are we going to determine whether there are conflicts between the guardian and the individual. That's really why we have substituted judgment and a more robust procedure with oversight by the permanent court. We lean towards uh thinking that is the better way to go rather than changing existing law and certainly changing it in this direction. So with that I'll just say thank you again for the opportunity to comment and we're available if you have any questions. SHOW NON-ESSENTIAL DIALOGUE
Um,
apologies. I was muted. Thank you so much. Mr Glasman, I appreciate so much your testimony and your thoughtful leadership. I think I lost you. You're you're still here. Um do have questions from my colleagues on this.
Okay. Um your concern is duly noted and certainly will take a good look4819 at this bill. Um4820 so thank you very, very much and I'm happy to see Representative Khan has joined Representative. We we looked for you earlier. I know it's a crazy day in the house, so I'm delighted that you're here.
[REP KHAN:] [HR2339] [HR2337] Yeah, thank you very much. Chair comfort and chair Decker Thank you for the opportunity to testify on House 33 to sorry 2339, an act establishing a commission on quality Patient outcomes and professional nursing practice. And yes, I was in stuck in 348, so I'm happy to be Back here at the hearing, so I'm really grateful for this opportunity to testify. Um if passed this bill would establish a diverse 17 member commission on nurse staffing in hospitals but within but not under the control of the executive office of Health and Human Services E ohh s. The commission would review and make annual recommendations to the legislature on the best nursing nurse staffing practices designed to improve the patient care environment, quality outcomes and satisfaction. Safe staffing is a complex issue and opinions vary significantly among the professional groups on the appropriate number of nerves versus needed to care to give good care to patients.
Research indicates that patient outcomes are influenced by a variety of factors including shift time, patient acuity and environmental conditions. The last lack of consensus on safe staffing staffing indicates a pressing need to examine and understand the issues facing the commonwealth nursing workforce. This commission would bring together professionals from across the healthcare spectrum to continue this critical dialogue with the ultimate goal of improving nurse satisfaction and quality patient outcomes by increasing transparency and evidence based research on staffing levels at our hospitals, massachusetts will ensure that our nursing workforce remain strong and vibrant for decades to come. So I really thank you4953 all for your consideration of this particular legislation and as a nurse, I really would like to see this happen. I think it would be a good move forward.
I also am here to testify on House 2337. An act establishing a special commission to study the integration of support groups in our health care4974 system and again. And I'm really pleased to have this opportunity Uh to speak about H- 237. And if enacted, this bill would establish a special commission charged with studying and making recommendations on the integration of support groups into the commonwealth health care system with the goal of increasing mental health and physical health outcomes for patients. While reducing costs. Far too many massachusetts, residents lack access to the mental health services and supports they want and need and for those who receive services is often only extended. Uh it's often only an extended period of struggling and crisis it serves and supports become when services and supports become available. Furthermore, social determinants of health such as environmental, social, emotional, economic and cultural factors have a significant impact on overall health.
But our current health care system is not adequately equipped to address these issues, often offering short term antidotes or medication instead of a truly accessible, culturally appropriate care. So, support groups allow individuals to come together to share their stories, experiences and lives in a way that helps reduce isolation and loneliness. Oftentimes individuals believe they are struggling alone, but a support group really helps them see that there are others5061 who may be dealing with similar situations and who can turn uh and can in turn get help that will help them in the future. So studies have documented that positive impacts of peer support groups on a myriad of health conditions including postpartum depression and fertility and diabetes really help. And I won't go on. But I just wanted to point out one group that came to mind where the where there is an integration of group support and health care are for folks who are choosing gastric surgery uh regarding weight issues.
And I think it's been shown that I think that5100 there is a requirement actually that in order to proceed with gastric surgery, you must be in a in a support group. And I think that's been extremely helpful to those that I've spoken to about that um issue and uh the actual help that the support groups has provided and then um you know, I think that if patients, if there5125 is this coordination physicians or nurse practitioners can recommend uh support groups and if they have particular support groups in mind, I think this would be very helpful and a great supplement to the health care that we are providing currently. So I would like to see us do more around support group into integration with health care. So thank you very much for this opportunity to testify this morning.
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Well thank you and thank you so much for forgetting here amid so much else work, other work. We know it's a hugely busy day in the house. Um Thank you so much and thanks for your leadership, especially5167 on pure support. Um that is duly noted and you have strong testimony. Thank you for helping arrange that during today's hearing questions or comments from colleagues.
Okay, seeing none will release you representative to more meetings. Um I'm looking now please for Russell roberts. Although I don't think I5189 see Russell on, but correct me if I'm wrong.
Okay. Um at this time I just want to check to see if anyone is on the team's meeting who believes that they have signed up to testify
or anybody I might have missed.
Okay, I'm seeing none.
Um uh Madam chair. I wonder if you would like to offer just a quick hello and um5224 thank you so much for all your work.
[REP DECKER:] Yeah, well thank you for for running an incredible meeting. As you have noted. It is a pretty busy day in the house as we begin debating how to um best use $3.5 billion from federal relief funds to really help those who are in need the most in our state. So thank you for for carrying this on and I don't know, you know, this was probably the most uh this was the shortest hearing we've had.5253 So maybe you need to share all the hearings if this is the pattern um while everybody who wanted to be heard was heard. So we always want people to actually have the chance to be heard. But thank you, thank you to my colleagues, thank you to everyone who has signed on and who's giving testimony and to everyone who is also submitted testimony and really can't, I need to just acknowledge my staff as well. Um thank you to Kate, Tain Marissa and Kathleen who have just been doing incredible work at really preparing all these um these hearings and really5283 doing their due diligence on a number of bills before us. So um thank you to everybody keeps safe and we'll be back at this tomorrow. Um both both debating I think the funds and another public health care in Indeed,
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Madam chair, thank you so much for your leadership on so many of these issues before the committee. I join you in thanking your team and just want to raise up brian and Julia and Keeton who helped with today's hearing. Um and with that friends without objection, this hearing has come to a close take good care everyone
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