2021-05-03 00:00:00 - Joint Committee on Public Health

2021-05-03 00:00:00 - Joint Committee on Public Health (Part 2 of 4)

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JEAN RAMSEY - BOSTON UNIVERSITY EYE ASSOCIATES - HB 2231 - So thank you Chair Comerford and Chair Decker. Um, I appreciate the opportunity to speak in support of this bill that Representative Barber spoke so well on just a few minutes ago. So I am a pediatric ophthalmologist and for people who70 don't know what that is, that means I'm an MD who takes care of eye problems in children and I've done so for nearly 30 years. So what I would like to do is take a few minutes of the time that I have to kind of set the stage for the conversations that our panel will be having and for others down the road because there is something special about children's vision and let me share two things with you.

Number one is many young children who have a vision problem and when I say that, I103 mean even with glasses that these vision problems can be reversed if we detect it and treat it early in life. So that's the good news. But the reverse is if we don't detect it, then they end up with a long life of reduced vision that was not necessary. So that's number one and number two is vision problems in young children can also interfere with learning. Um, we know this now from many national studies that young Children with vision problems not only do they not see well, but they also do not perform well on tests of early literacy. And frankly, this was shocking. These early literacy skills are fundamental for a child learning to read. And as many as 15% of young children have vision conditions that may157 interfere with their ability to learn and to read.

We greatly appreciate through the years, the legislature has really been supportive of children's vision and Representative Barber alluded to it in 2004 passed the first time in the country, a mandated preschool vision screening legislation. So that has certainly been good and many children have been identified as having a problem through that. But again, is Representative Barber mentioned, you know, it's not perfect, nothing's perfect. A lot of kids are falling through the cracks. The current 2231 would further expand the scope of the vision screening, but gaps still persist, not just division screening but also in follow up care and in treatment and all these gaps need to be remediated in a timely fashion to have a good result.

So it is a complex problem. And for that reason, the bill also talks about an advisory council that could provide a surveillance system and monitor vision care throughout the commonwealth and ensure that all children get the care in an equitable fashion. So just to summarize a couple of points, no child should suffer from vision loss that's reversible if treated early. And no child should suffer a deficit in reading skills because of untreated vision problems. And this undoubtedly will have repercussions down the road. So we need to intervene early. Vision is an important tool for learning. And House bill 2231 would be a giant step in not just improving vision but also improving learning for children in the commonwealth. So we're grateful to the support of legislator over the years and certainly to Representative Barber for being such a great champion of children's vision. Thank you.
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PAULETTE TATTERSALL - CVMA - HB 2231 - Thank you everybody. Thank you Chair Decker and Chair Comerford and committee members for hearing our testimonies today. As the Northeast director of Prevent Blindness and co chair of Children's Vision Massachusetts Coalition I'm testifying in favor of H 2231 an act improving child eye health. If passed, this legislation will build upon the 2004 Act relative to eye exams for children, which as Dr. Ramsey said, elevated the importance of vision screening and placed Massachusetts as a leader in the nation for children vision screening requirements. So passing of H 2231 moves this foundational work forward by supporting optimal vision development and learning for every Massachusetts child.

Children's Vision Massachusetts Coalition is a 17 member coalition with representation from optometry, ophthalmology school nursing pediatrics, public health education and families. Our diverse cross collaborative stakeholders allow us to use broad approaches toward our mission of an equitable, systematic approach so that every child has the opportunity to develop and maintain their best possible vision. And we invite you to review our submitted materials. As you're aware vision screening is the important first step in an effective system of vision care for children. But vision372 screening alone is of limited value if after identification, follow up on eye exams do not occur or treatment plans are not followed.

Significant system wide gaps in Massachusetts children vision care exist but cannot be supported by data because the state does not have a method of surveillance. Since 2004, we have relied upon our child vision screening law but we do not measure its effectiveness. We lack399 performance measures to inform decision makers on the status of childhood vision, but the404 state neither understands the extent of eye care or case management that does occur or has a robust system411 in place to ensure that all children who have been identified as requiring vision evaluation by an eye doctor receive that care throughout their childhood. This void in our knowledge and in our system creates unnecessary disparities. Only those children with naturally better sight or well corrected vision thrive and are ready to learn and those without fall behind.

H 2231 would establish a permanent broad based council to guide collection of data across the Commonwealth, identify whole system deficiencies and design and implement interventions with targeted resources. Massachusetts has some of452 the building blocks already in place. Today we ask for the opportunity to do more. There is a general lack of awareness and understanding about the far reaching effects and inequities created for many of our children solely because of their untreated vision problem. Passing of H 2231 now will move our state forward477 to an accountable data driven cross agency, collaborative, systematic approach to eye care from which all482 children across the commonwealth can benefit. Thank you for considering my request to support489 this legislation.
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SHANYN TOULOUSE - MSNO - HB 2231 - So, Good afternoon. Um chairs Comerford and Decker and members of the committee. Thank you so much for taking the time to hear and understand the important concerns related to Children's vision and eye health today. Across the commonwealth. Thank you to Rep Barber for filing House 2231 and to senator. Yeah, senator as well. My name is Shanyn Toulouse. I am a nationally certified school nurse and I've been performing and training others to perform vision screening since 2001. I also had the great privilege of serving on the Special Commission for Children's Vision in 2018, representing my professional organization, the Massachusetts School Nurse organization. So yes, I have some professional knowledge and experience with the critical nature of timely identification and treatment of children's vision problems.

I am also a person with a corrected vision concern. As you can see I'm using glasses here today And I distinctly remember the very first time I put my glasses on my face I was 12 years old. I did not want to wear glasses. I feared teasing and name calling and as unreasonable as this seems to me as an adult today, it was very real to me as a young girl. But from the moment I placed my new glasses on my face, the world just opened up in an entirely different way. And here's the real issue I had no idea that I could not see.586 Prior to using corrective lenses I thought that stars in the sky were a myth. I thought that trees grew into one very large canopy. Um, It was a school nurse who performed a vision screening and then notified my parents of the need for further assessment and treatment.

I was lucky because the system worked for me. I received the vision care I needed. Was it because I was a middle class, privileged white girl and my parents had access to resources that allowed me to receive proper care? Probably, was it because a school nurse alerted did my parents to the problem? Absolutely. Not all Children are this fortunate. Vision health should not be a privilege that is accessible625 to only those with the resources or even the knowledge that a vision concern may exist for their child. In my years as a school nurse,634 I've seen the devastation that can occur when a child's vision problem goes unrecognized and untreated. A child's social, emotional wellbeing, their motor and development and their ability to learn and read on grade level as well as their behavior can all be negatively impacted.

Here are just a few of the many examples that I've seen as a school nurse. I've seen children fear climbing up a slide um due to the inability to see the ground and658 fear for falling and being hurt. This type of behavior can limit motor development and muscle development and even lead to social isolation. I've witnessed children suffer punitive consequences of misinterpretation of their movement around the classroom in order to see as misbehavior or even misdiagnosed and treated for conditions such as ADHD. I want all children to live their best lives, to run into play, to climb up the slides and to be happy. To be able to read on grade level with their peers to see leaves on trees is in the stars in the sky. Every child in Massachusetts has the right to proper vision care and you can help make that happen today by supporting House Bill 2231. I'm asking for your full support of the bill. Thank you very much.
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REP KHAN - I Just wanted to again thank the panel. I think that like you, I was 13 when someone recommended that I have my vision checked. And I was shocked when I came out with my glasses I could actually, I hadn't realized that you could actually see the leaves on trees. Uh you know, the individual leaves. So it's just incredibly important. So thank you for all the work on this and thank you to Rep Barber as well.
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REP HADDAD - HB 2311 - HB 2312 - Thank you so much for taking me out of turn. I'm sorry I was on another Zoom as we all are. So um good afternoon to all the members of the committee and to you. Um, Madam Chair Decker and Madam. Chair Comerford. I'm here to um comment or813 uh testify on two bills. Um H 2311 is an act clarifying participation in athletic safety programs. So as you know, we have a requirement that says824 that every year coaches, athletic directors and parents of young athletes have to participate in head injury training. Um My bill would make it every two years and not because I don't agree with the core intent of the bill because I do, I'm a former phys ed teacher and coach and this is an extremely important process, but it has become administratively and financially burdensome to the schools.

So I would um, the language also reflects input from DPH and um, so I would just ask you to consider allowing the schools to do it every other866 year um in order to fulfill their requirements. The next one is House 2312 an act relative to conducting fetal and infant mortality reviews. Um, I know that there have been several other bills filed on this subject. This actually is a bill that I picked up from our good friend, Jeffrey Sanchez and889 um, you know, have been filing it for him. We know that it's very odd, but we are, we have a very high rate of infant mortality for an industrialized country. So what this would do is, um, uh, it will guide the Massachusetts907 Department of Public Health to develop criteria in relation to local expertise and workforce capacity, which, if met, would permit local health departments to obtain timely access to vital records that are required for the review.

Um, There's no other926 explanation other than I feel very deeply that we have identified, especially with COVID that there are some934 real disparities most shockingly between babies born to black women and to white women. So I will just ask that um the committee give this a great deal of attention. And951 I don't care if it's my bill or any of the957 other bills that have been filed. I just feel that this is a, these are statistics that we need to be paying much closer attention to because if we don't we're never going to be able to change um what's going on. So thank you again. Um If you have any questions I'm happy to answer, but I would hope that um you ladies madam chairs would take this on um as a committee because I do feel that985 it would be helpful in all of the other things that we've been doing about Uh you know much the other Mortalities and the problems that we have with births and and mothers with issues in pregnancy. So thank you. And like I said, I'm here for questions.
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SEN DIZOGLIO - SB 1410 - SB 1427 - Yes, madam Chair, thank you so much for recognizing me out of turn. Uh And good afternoon everyone. Good afternoon madam chairs and good afternoon members of the committee. I am coming before you today to advocate on behalf of two bills that I have filed Senate Bill 1410 an act relative to newborn infant products. And Senate Bill 1427 an act relative to student heart health. With the passage of Senate Bill 1410 The Department of Public Health will promulgate rules and regulations to establish a set of guidelines on the use of products on newborn infant in a birth center or a facility that include any of the following chemicals or ingredients.

1,4-Dioxane, formaldehyde, fragrance ingredient, nitrosamines. And I'm, saying them the way that I'm trying to actually read these off of my statement right now and it's difficult for me to even know what these are or to pronounce in the right way which probably means they shouldn't be in these products. Uh propylene glycol and I'm reading a host of different ingredients that we're discussing here today that the Department of Public Health should be looking at triclosan. DPH would promulgate rules1097 and regulations in relation to such ingredients at these centers or facilities that provide or offer these gifts products containing these ingredients to a parent of a newborn infant.

And newborn products are generally marketed to the public as safe and gentle on our precious babies. But in reality, however, many of these products include chemicals that are linked to skin allergies and some have even been linked to cancer. I'm seeing Talc on this list. I was inspired to file this legislation by my wonderful constituent from North Andover Kim Malika, who has been a tremendous advocate on this issue and will be providing testimony today to explain why the bill is so important if she already hasn't. Um, and I'm looking forward to working alongside of this committee to ensure that we do all that we can to protect our newborns across the commonwealth.

With the passage of the second1157 piece of legislation, Senate Bill 1427 Massachusetts will establish long overdue guidelines as it pertains to protecting our youth against heart disease, anatomical and electrical abnormalities of the heart, cardiac distress and sudden cardiac arrest during sports. When talking about athletics, the problem of preventable heart complications is very real. Every year we're seeing more athletes collapse mid game, die after a match or retire due to heart complications. This topic is eerily reminiscent of the concussion conversations we're having now in our society. For years, concussions were ignored. We know this. Kids were told to shake it off and the lives we've lost because of this ignorance will truly haunt us forever.

Only recently are we coming to terms with the impact concussion, with the impact that concussions are having on our youth. And sadly for many of the athletes, it's too late. So today you'll also be hearing from the organization, Mass Heartbeat will speak to the urgency around addressing these issues. The bill would task the Division of Prevention and Wellness to develop a sudden cardiac arrest and death prevention program in which all public schools shall participate. Coaches, trainers, parents and other school officials affiliated with public school sports programs would be required to take this training annually to ensure they are educated on identifying the warning signs of an athlete having a heart complication.

In addition, the bill would task the department to disseminate information regarding the availability of electrocardiogram screening organizations in Massachusetts, that specialize in1262 administering voluntary ECG tests with an ultimate goal of expanding the voluntary taking of these tests to prevent tragedies from occurring. It would also allow the implementation of a preventative screening program at the discretion of coaches, trainers, athletic directors and other school administrators. And finally this bill would establish training and clear criteria for the quote removal of play and quote of an athlete. And this criteria includes identification of a cardiac event occurring during an athletic event, the removal protocol and the steps necessary for the athlete to safely return to the sport. Um Let's not be too late on this issue. Let's be leaders on heart health uh and safety protocols. And I want to thank you once again for your time and for your consideration of all these matters and once again madam chairs members of the committee. I look forward to working with you on these issues.
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SAMEER SABIR - CONCERNED CITIZEN - HB 2261 - SB 1439 - Um firstly I'd just like to thank the committee chairs and the committee for listening to my testimony today and to Chair Decker and Senator Friedman for Championing this legislation both in this session and in the previous one. My name is Sameer Sabir. I am a parent who lost the child whilst living in Cambridge and I'm here to speak to you today about my personal experiences, how they more broadly relate to the systemic issues that have existed for many years uh in the office of the chief medical examiner and how this very simple legislation would have a profound effect on how child deaths are handled in the commonwealth.

In January of 2013 on our daughter Rahma's first birthday, she was found by my mother having seizures after having been in the sole care of her caregiver that day. She was rushed to Boston Children's Hospital, where despite the efforts of her wonderful doctors, nurses and support staff, she succumbed to her injuries uh and died two days later. Rahma was evaluated and treated by an extensive interdisciplinary team, including EC doctors, ICU specialists radiologists, neurologist, ophthalmologist, hematologists and others. Uh and the clear and consistent finding of this team was that Rahma died of abusive head trauma, also historically known as shaken baby syndrome.

Uh The associate medical examiner who performed Rahma's autopsy initially reached the same conclusion and her caregiver was indicted for homicide. Uh At that point, a chain of events occurred that highlights many of the deficiencies that we are here to address today. At that point, the caregiver's legal team and their paid medical experts uh lobbied the associate medical examiner extensively through direct access, providing her with their expert witness testimony and urging her to revise her opinion, even though the legally correct procedure would have been to introduce this evidence at a trial in front of a jury. Uh The associate medical examiner did ultimately revise her opinion from homicide to undetermined Uh and this led to the criminal prosecution being dropped despite a plethora of other evidence from our apartment, of a violent altercation, including blood on bed clothes and damage to an apartment wall.

Uh And critically, the associate medical examiner who had little experience at the time performing child autopsies was able to make this decision unilaterally and without the review or supervision of1512 her supervisor, uh the chief medical examiner. Uh and she made a finding that was in direct contradiction to a large world class medical team uh, that treated her. Sadly this was not the first or the last time that this has happened. Uh, Patricia Wen of the Boston Globe conducted an in depth investigation of this issue uh in 2016 titled medical examiners can be a jury of one uh in which he states, and I quote, a Globe review found a highly decentralized system of ruling suspicious deaths in Massachusetts, in which forensic pathologist are given extraordinary freedoms to make and change their rulings with little scrutiny of what factors, including personal ones may have influenced them.

Uh And then later in the piece, she says in this extraordinary series of revisions, the examiners became powerful, de facto judges wielding tremendous pretrial clout whilst operating outside of public view and without fear of being overruled. We live in the premier hub of the medical and scientific expertise in the country and we can do better. Our legislation is very simple and it asks that any finding of a death in a child aged two or under is reviewed and approved by the chief medical examiner and that the same occurs if the finding is revised. Uh, I'd just like to say this is not a novel or extraordinary concept. It is in fact well accepted practice that many1595 other medical examiner's offices around the country and it's just good practice.

Uh this would go a long way towards addressing not just instances of conflict of interest or biases of opinion, but the simple fact that fortunately the number of autopsies performed on children under two is uh is very small. And that makes it difficult for medical examiners to build experience just like a heart surgeon who only does five procedures a year, would not have as much experience as a heart surgeon who does 200. Uh, so in conclusion, this is simply about arriving at the right answer uh, about accountability given the indescribable toll this1626 takes on loved ones. And importantly, making sure that1629 people who hurt Children are prosecuted, but also ensuring that people aren't falsely accused of hurting children. This is uh, this is a very neutral piece of legislation.

So I would, I would respectfully urge the committee to report favorably on this bill uh, and helped to advance the public's confidence in finding around child deaths. Uh, and if I1648 may decide quickly, Dr. Bob Sege, who is a national expert on child abuse was due to testify today on behalf of the Massachusetts chapter of the American Academy of Pediatricians. Uh, he had a conflict, but we worked with him and with this group for a long period of time. It's an issue that the pediatricians at the state care deeply1667 about. Uh, and as they will point out in their written testimony, just as adult medicine1672 is different from pediatric medicine. Adult pathology is also different from pediatric pathology and that equipping the ME's office with the appropriate procedures will lead to more confidence in their findings. And that can only be a good thing for1682 the children and the parents of the commonwealth. So with that. Thank you very much for listening, appreciate it.

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REP DECKER - HB 2261 - A few things that I just want to share is that the urgency of this is pretty clear. And this year I have refiled it with Representative Harrington who has joined me. Representative Harrington, I met with the chief medical examiner a year and a half ago, prior to right before COVID. And it was, it's clear that Governor Baker actually could just do this. We don't necessarily need a legislation to do this, but because they're not doing it, we do need legislation. The chief medical examiner who sat and met with both myself and Representative Harrington made it very clear she didn't think that it should be part of her responsibility. Um The number of um uh cases that are involving children under the age of two are very small.

It's um absolutely the chief medical examiner as a office has the bandwidth to1795 do this. And the fact that the highest paid public servant in the state of Massachusetts did not want the responsibility to do this um means that because the administration won't move forward with this. We are moving forward with this as a bill, I will say Um Sameer the, the generosity and the determination of you and your your wife to continue to come forward to ensure that families don't go through what you've been through. Um is um really I can say that I speak with incredible gratitude. This was a story that I um recall both as a Cambridge resident. I remember paying very close attention to this incredible loss in your life. Um and then um having the opportunity as a legislator1842 to work with you in ushering this.

I do believe had it not been for the pandemic, we would have1847 actually moved this bill forward for a vote. Um The only person that seems to be in opposition of this was the chief medical examiner. Um I believe we even had um maybe not formal, but certainly the the messaging of support from even the Secretary of Public Safety at that time. Um So I think this is why we file legislation because we represent the intent and the will and the needs of our constituents. And um that if this becomes something the chief medical examiner, doesn't feel like they can add, then we have to revisit um what it means to be chief medical examiner.

I will also say one of the things that became clear that we have not had any answers on, and I don't think you have either is that there was a time in which the chief medical examiner would provide referral and services to families grieving to Children's Hospital. And we asked why this was no longer done, we did not get an answer that satisfied myself nor Representative Harrington, who has also been working on these issues very closely. So we will continue to do that work.
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KHAN - Uh so um I just had a question. I mean it's such a very sad story and I appreciate that Sameer um has come today to testify and that you Decker have1946 filed this legislation. I guess my question is has there been any thought about the child advocate? Is there any opportunity here to think about the child advocate playing a role uh regarding sort of oversight with the medical examiner or some uh sort1962 of possibility that there has to be uh some kind of um work with the child advocate? I mean it's considered it was considered child abuse. And so I'm just wondering why the child advocate wasn't notified or brought into or maybe maybe she was, but I don't I didn't hear that, so I'm just wondering about that possibility.

SABIR - Um if I could respond quickly. So we did actually engage with the office of the Child advocate recently and had a meeting with them to discuss this issue. And I also understand that the Child Fatality Review Committee Program1996 is in the process of being shifted from the office of the chief medical examiner to uh the child advocate's office. So I think they do have an interest in this. Um And I think that will continue to uh evolve uh over time.
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SEN RAUSCH - Thank you so much, Madam Chair. I just wanted Samir to express my deep sympathies. I'm so sorry for your loss. I remember the story hitting the2034 news um and it's just it's2037 a it's really terrible. I'm a parent of young children myself and and my heart goes out to you um as well as my gratitude for turning your absolute unimaginable tragedy into dedicated advocacy. Excuse me. Um And I look forward. Thank you Madam Chair for filing the bill and um and the other colleagues who have joined you in filing the bill and I look forward to supporting it.
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SEN COMERFORD - Samir thank you. I agree wholeheartedly with Chair Decker and Senator Rausch in terms of our gratitude to you for transforming this tragedy into um what will hopefully be greater care for families like yours and totally deserved greater care. I just want to double down on what Chair Decker said this bill had quite a lot of momentum in the joint committee last session. Uh It made it very far. Um And you know, I think you can tell by some of the comments today that there is a lot of interest in this bill. Um And I look2126 forward to working with Chair Decker on moving it forward.
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JONATHAN REIDY - ATOM - SB 1526 - HB 2233 - I just wanted to thank everybody for the opportunity to provide testimony today in support of Senate Bill 1526 and House Bill 2233 an act relative student safety in interscholastic athletic activities. Um My name as I said, my name is Jonathan Reidy. I've been a certified athletic trainer for five years. I've spent the majority of that time of my career working in the secondary school setting. Uh I currently serves as the chair of the Secondary Schools Committee for the Athletic Trainers of Massachusetts.2205 I'm also the manager of athletic training services at Shriner's Children's Hospital in Springfield. Where I oversee our outreach athletic training program, providing athletic training services to2214 secondary schools.

Athletic trainers play a number of critical roles in the secondary school setting. Unfortunately, often the public thinks of just taping ankles and providing ice bags. What most people don't see or realizes that more often than not the athletic trainer maybe doing 10 other things or prepare for other things to happen at any given time. Today I would like to take a moment to focus on, you know, our preparedness for providing emergency and acute care to student athletes. We're constantly focused as athletic trainers on being prepared to handle a wide variety of emergency situations. Uh, you know, this, this includes having the knowledge, the functioning equipment, a well laid out emergency action plan and the ability to execute it.

Far too often we read stories in the news, you know, where student athlete dies from arguably preventable cause. More often than not, these are preventable Um, with the skill set of an athletic trainer being present. Um,2268 you know an athletic trainer is the healthcare provider designed to handle these situations in the secondary school setting. Uh they're especially educated and trained to handle these types of emergency situations. I'd like to highlight a couple of recent cases. Um, some of you may have or may not have heard about recently. At Atkins High School in Winston-Salem North Carolina, a JV, soccer player collapsed during a soccer practice. His athletic trainer was on site and immediately executed their emergency action plan, initiating CPR and activating EMS.

Because of that immediate recognition action that player was revived and actually speaking on a stretcher before they left by ambulance. After Senator apologies if I missed this does DiZoglio's testimony earlier this seems like an even more relevant example of why we need to have a qualified healthcare provider on site at our secondary school2315 secondary schools. The second story I want to share is a little bit closer to home. Um, you all may be aware of the unfortunate situation with the hockey player that occurred earlier this year in West Springfield Massachusetts. That player crashed headfirst into the boards, resulting in what we suspected at the time was a spinal cord injury, which required careful, immediate management.

I was the athletic trainer on the ice with that athlete. Um, and was able to recognize the severity of that injury right from the get go and activate our emergency action plan for that site. Had there not been an athletic trainer there Um, you know, that injury could have been severely mismanaged, potentially causing further harm or worse for that student athlete. These are both examples of student athletes who are fortunate that they did have an athletic trainer available to them. In Massachusetts there are still over 30% of secondary schools that do not2362 have athletic training services available to them.

These student athletes are at risk every day by not having an athletic trainer there. We know that 62% of sports injuries occur2371 during practice, not during a game. So not having somebody there can be a big problem. With that Uh, you know, I would ask for your support and passing this legislation. Uh, this is a step to proactively provide high quality health care to all student athletes in Massachusetts secondary schools. Uh, thank you for your time and consideration and support of this bill.
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ROBERT COLANDREO - ATOM - SB 1526 - HB 2233 - So good afternoon. I'd like to thank Chair Decker and Chair2413 Comerford for the opportunity to speak in support of Senate Bill 1526 and House Bill 2233. My name is Robert Colandreo. I am the program director of the Athletic Training Program at Bridgewater State University and the current past president2426 of the Athletic Trainers of Massachusetts and a per diem clinical athletic trainer at Matignon High School in Cambridge, where I actually began my athletic training career back in 1995. Athletic training is a healthcare profession recognized by the American Medical Association.

Athletic trainers are under care in collaboration with the physician in accordance with our education. Athletic trainers are unique healthcare providers as we provide care predominantly to2449 student athletes, but we have a sort of set that's being looked at by other professions. And our role in the high schools can't be minimized. Um we do everything from keeping a patient with an after hours ankle sprain out of the emergency department, which is the2468 most expensive entry point into the healthcare system. So planning for a student athlete's safe return in the midst of a pandemic.2474 We do not allow our students to attend school without a school nurse. Swimming pools at schools cannot open without a lifeguard. Yet we allow thousands of Children to participate in high risk athletic and extracurricular activities daily with no medical personnel available.

Our school nurses leave at the end of the formal2494 school day. Senate Bill 1526 seeks to update current state law to align with the current MIAA Rule for medical services required at high school football games and requires secondary schools with athletics to hire an athletic trainer. A physician or EMS services are mandated to be present in all high school football games regardless of level. The MIAA Rule requires a physician, an athletic trainer or an EMT be present at all games. Varsity games on Friday nights or Saturdays typically have a physician or EMS present along with an athletic trainer. The problem arises with JV. And freshman games, which take place during weekday afternoons when only the school athletic trainer is present.

Schools want to have an athletic trainer present as we can make a return to play decision and evaluate a concussion, which an EMT cannot. Physicians are still usually working in their offices,2546 seeing patients and this disconnect sets up a liability risk. This bill will also require schools to hire an athletic trainer. Licensure for athletic training was enacted2556 in 1983. The goal of the legislation was to provide an athletic trainer in every high school sponsoring athletics. In his 1988 athletic training licensure Sunset review, State Auditor DeNucci noted a need for statutory and regulatory modifications to ensure an athletic trainer in every high school. We've come a long way. Approximately 65% of schools today have an athletic trainer, versus 26, which we had in 1988.
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COLANDREO - We've come a long way. Approximately 65% of the schools with the athletic programs in Massachusetts have an athletic trainer, versus 26 back in 1988. But we need this bill to give us the final push to complete this endeavor. We're going to be providing some additional testimony today on a handful of other bills. Um, we'll do that in writing, but I'd just like to thank you again for the opportunity to speak and we request on behalf of your student athletes and the communities that you represent that this bill be reported favorably out of committee.
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JENNY GORMLEY - MSNO - HB 2335 - SB 1401 - Well, good afternoon and thank you to chairs Comerford and Decker and the joint committee members for this opportunity to speak to you about the postural screening bills that's SB 1401 filed by Senator Cyr and HB 2335 filed by Rep Kay Khan. My name is Jenny Gormley and I'm the immediate past president of the Massachusetts School Nurse Organization, which is a professional group of 800 Massachusetts school nurses. This is the third time MSNO has filed this postural screening bill with the same language and during the last two legislative cycles, the bill moved out2718 of this joint committee with no individual or groups opposing the bill.

Last year the bill died in Health Care Financing, as did other bills due to COVID and we've been hearing about that. There is no financial impact with this bill. We are advocating for a decrease in the frequency of postural screening from five grades. That's grade 5, 6, 7, 8 and nine for all students annually to once annually for students in these grades. And this mandate comes from a Mass general law that was passed more than 40 years ago. Senator Cyr spoke eloquently about how awkward this can be for youth and uh essentially trained school nurses and physical education teachers conduct the screening. Uh the boys take their shirt off and the girls wear a bra or bathing suit. And the screening is often done in during PE class, in the gym or in the health office.

Um and it can take a full class period to screen a class of students. And so we're supporting this legislation to reduce the frequency of postural screening because critical time on learning is lost over five grades. And The US Preventive Services Taskforce, a group of experts do not recommend routine postural screening. We know that many parents and2807 guardians opt out of the screening. Each year we're hearing reports of up to 60% opting out of the screening from our school nurses. And we also know that pediatricians perform the possible screening as part of the physical exam. We believe that school nurse time is better used for other screenings, such as vision screening as we've heard about earlier. And the universal experts substance use screening in two grades is required by a new law that 2016 Step Act.

Also, school nurses are supporting students with mental health challenges and they are making efforts to reduce vaping in youth and as we all know to reduce infectious diseases in schools whether it's COVID this unusual time or the flu every year. There are only seven states2861 including Massachusetts that require postural screening by law and those that do require it only in one or two grades. And so I want to thank you so much for your attention to this bill and I hope that you will support a favorable report out of2881 your committee. Thank you.
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DEBORAH EAPPEN - ATRIUS HEALTH - HB 2261 - SB 1439 - Um Thank you for having me. I appreciate being here. I am here because my son Matthew Eappen was also a victim of abusive head trauma in1997 at the hands of our, Louise Woodward. Um You might remember that time period in October, it was referred to as the nanny trial on court tv. My son Matthew was treated at Boston Children's Hospital where after careful examination, blood work and brain imaging was performed by child abuse pediatrician. The diagnosis of abusive head trauma was made. Matty2988 was found to have a 2.5 inch skull fracture, severe brain swelling and bleeding and extensive retinal bleeding. He never regained consciousness and2997 died in our arms five days later.

We were devastated by his sudden and violent death after donating his heart bells to try to save other Children's lives. His body underwent autopsy at the medical examiner's office. His eyes were examined at, I received his death certificate in the mail on my birthday. It read homicide, blunt force trauma. An intense police investigation resulted in the arrest of our childcare provider. Nine months later, a trial ensued that resulted in a jury verdict of guilty of murder in the second degree. Unfortunately, Judge Hiller Zobel became the 13th juror when he reduced the verdict to manslaughter and sent the3047 perpetrator home on time served. This was an additional victimization by the system, but I tried to console myself by reminding3056 myself that the jury who heard all the evidence, understood the truth of what happened and that the perpetrator remains convicted of a felony and is held accountable for causing Matty's death.

The violation of my son Matty is the worst experience of my3076 life, but the excellent medical care at Children's, the professionalism of the police and DA's office and the integrity of doctors who treated Matty and testified for the prosecution helped me feel that the truth mattered. So I can't even imagine the pain a parent would feel if they had such a devastating loss, only to be followed by a solo assistant medical examiner who may never have performed an autopsy on an infant, deciding singlehandedly and based on no pediatric subspecialty pathology training, the cause of death of a previously healthy infant.

Even more unbelievable would it be if a medical examiner who was only at the level of fellowship training at the time were to leave the medical examiner's office for another job in a different state and more than a year later, come back and change the cause of death in an autopsy on an infant from abusive head trauma, homicide to cardiac arrest has happened in this state. This would have severe consequences for the family in many ways because the medical examiner unilaterally, with no oversight from a more experienced chief medical examiner changes the cause of death. It may actually make the District attorney's office hesitant to prosecute the case and bring justice to the family. As you may know, I am also a physician and physician training and practice is carefully regulated.

We are used to oversight. We are used to working as hard as we need to and3177 collaboratively in order to come to the correct diagnosis. I'm sure this would apply to the assistant medical examiners. Surely they would want to come to the most3188 accurate diagnosis in the death of a child, especially since there are such meaningful consequences for the family. The medical examiner plays a crucial role in establishing the cause of death, clearly and unambiguously when the evidence indicates it should be so. The child's body tells the story of what happened3208 to it and it is the medical examiner's finding that so importantly leads to prosecuting a person who has taken the life of an innocent baby by child abuse. While there are thankfully few infant deaths annually in Massachusetts, shouldn't we as citizens of Massachusetts with the best hospitals and medical training in the country, be sure that there is a system of quality and oversight in our medical examiner's office? I think so. Thank you very much.

DECKER - Dr. Eappen, thank you for coming forward and sharing your story. I think many of us I know certainly myself, um, watch that trial very carefully. Um, and my, my heart as as a mom as well, also, um, aches for you today and I really appreciate you taking the time to come forward. Um, the only person who opposed this bill was the chief medical examiner who made it very clear she did not want the responsibility, the highest paid public servant in the state. Um, and so because that seems to be the impetus we have to file. This as legislation as opposed to this being done administratively. Um, and I really look forward to um working with you and with Samir and with my colleagues. And3292 um and moving this bill forward.

No parent should have to wonder why whether or not the person who has3299 provided the pediatric pathology um while grieving the loss of their infant, whether or not that person is competent enough or experienced enough because as we've heard, it's really the lack of experience because it's so rare and so really accountability is with the most experienced person in the office and that is the chief medical examiner. Um So I um I really appreciate you coming forward and I and I continue um, to just share my gratitude for you. Um, and thank you.
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WINTON PITCOFF - MA FOOD SYSTEM COLLABORATIVE - HB 2277 - Thank you. Thank thank you to the chairs and to the committee and thank you especially to Representative Duffy um for as one of her first stacks and one of the first bills that she filed as a, as a representative for introducing this important bill that would require that school wellness policies include consideration of school gardens. School gardens have been proven to have positive outcomes for Children as they learn about nutrition, food production and natural resources. Many schools in Massachusetts have already integrated school gardens into their curriculums and this bill would encourage others to do the same. So we encourage the committee to also amend this bill to require that wellness policies also include explicit language about students being able to eat food grown in school gardens.

Oddly that's something that's not always a given because of challenges with local boards of health. And also the school gardens be integrated into curricula rather than being an optional extra curricular activity. We'd also like to see wellness policies include plans for training teachers and nutrition and agricultural education. We'd like to see them support nutrition and food system education at3489 every grade level. And we'd like3491 to see a requirement that wellness policies include implementation plans, including annual assessments of implementation in the school environment with metrics that demonstrate impact to the wellness efforts.

Wellness policies are incredibly powerful tools for schools and school districts. And we want to make sure that schools are using into the fullest, fullest capacity. We know that this kind of education has a positive impact on student and family health as they learn to eat more nutritious food. It helps with job readiness as they learn about careers in the food system, which employs about 10% of the Commonwealth's workforce and it helps support the local economy and protect natural resources as students learn about the3532 value of buying local foods. These efforts don't3536 have to be burdensome mandates on teachers or school administrators.

There are many models of how these important subjects can be integrated into STEM curriculum and can enhance existing lesson plans and classroom activities. Massachusetts Food System Collaborative has provided written testimony to the chairs and can provide further information about these suggestions at the pleasure of the committee. And we look forward to working with Representative Duffy and the committee on revising the bill's language. Thank you to the committee for your consideration.
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JASON MCKAY - RANK ONE - SB 1495 - Thank you, Chairwoman Comerford, Chairwoman Decker and assembled members for allowing me to address this committee and Express our strong support for S 1495. My name is Jason McKay I'm the chairman and CEO of Rank One. For nearly 15 years, educational institutions across the country have been using our comprehensive software suit to manage athletic logistics, health tracking and administrative requirements. The Rank One platform streamlines the process of documenting a3632 student's sports related injuries, provides real time sideline consultations with medical experts via a secure video communication and coordinates care with the students preferred physician.

Rank One's platform allows seamless secure communication between the school medical professionals and student guardians and full compliance with HIPAA and, to help combat international health challenges all of us faced in the past year. Additionally, the platform provides pre participation screening, contact tracing to help mitigate whatever public health challenges we face next. Nationally Rank One is active in approximately 4000 schools, covering 33 states With nearly 4 million middle school and high school students covered. Through active daily utilization by thousands of certified athletic trainers across the country, Rank One has compiled what is believed to be the largest pediatric sports injury database in the country.

For this reason,3688 I want to express our support for the creation of this program to3695 track and categorize health and injury data As we begin to re enter3701 schools and sports schedules3703 revert back to normal. Now is the time to make certain we as a collective group, think about sports and activities related injuries in a3713 way that ensures we are using data to keep our student athletes as safe and healthy as possible. Rank One currently serves over 11,000 students in eight school is located across four districts in the Commonwealth of Massachusetts. With3726 the data points we are able to collect and appropriately share with administrators, can have deep impact on the future of athletic programs in schools. Should we build a turf field of grass field? Have concussions decreased among athletes who we took precautions.

Not to mention the non identifiable meta data that can be3744 used by research institutions to propel Massachusetts to the front of the pack in student safety. We wholeheartedly believe that every state should commit to tracking student injury data for the safety of every student3756 athletes. Massachusetts is on the cusp of being at the vanguard of student protection and safety. The establishment of this program within the3764 Department of Health will3766 show that the commonwealth takes education safety of its students seriously. Regardless of the outcome of any potential contracting process Rank One Health and Rank One are here to assist the committee and the commonwealth and developing a program focused on safety and participation that places our students health and safety first. Thank you for your time today and thank you for taking this initiative.

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