Senate Standing Committee on Health and Human Services

Calling the hearing the 1 o'clock hearing for the Committee on Health and Human Services. Our first hearing of the 2025 session. Present with me is my Vice Chair, Senator Aquino, and and a new Member, Senator Fidela. So this meeting is being streamed live on YouTube.

In the unlikely event that we have to abruptly end this hearing due to technical difficulties, the Committee will reconvene to discuss any outstanding business on Wednesday, January 292025. 1pm in the same room, CR225. For those on zoom, your audio will be muted and video disabled until shortly before it's your turn to testify.

For this hearing, we are going to allow each testifier to have two minutes to testify because we're all new. For those of you who have been with me in prior sessions, we are going to limit it to one minute. So just be forewarned. Have your written testimony available, because I do read all the written testimony.

If there's a technical glitch during your time to testify, we may have to move on to the next person due to time constraints. I will be reading a list of individuals who submitted written testimony for each measure. We apologize if the closed captioning does not accurately transcribe the names.

If you are interested in reviewing the written testimony, please go to the Legislature's website. You will find a link on the status page for the measure. We appreciate your understanding and remind you that community does have your testimony, that I have reviewed them. So I encourage you to use your time to either add additional comments or.

Or just stand on your written testimony. And for those of you who have met my staff, we do have a brand new staff with Lewis back there and Juliet. Okay, so be patient with us. So first up, SB200 relating to speedy trials, we have William Bento, Office of the Public Defender in opposition.

Good afternoon, Chair and Vice Chair. Members of the Committee, my name is William Bento. I'm a deputy Public defender. First of all, let me apologize. We have the wrong heading on our testimony. That's fine. But the testimony regarding this Bill. We do respectfully oppose the Bill for several reasons. I'd just like to highlight one.

The Bill does, I believe, create a duty for the prosecutor to have to take into consideration the rights of the victim or the child witness or other witness. In this type of case. That creates a conflict of interest because the prosecutor then has to weigh what happens to the interests of those witnesses against their entire case.

That can be problematic. Witnesses may be called upon to have to testify just for a motion to continue, which could be traumatizing and really undermines what the bill's purpose is for.

The other thing is that it can actually make a witness or a complaining witness a party to the case wherein they could have their own attorney come in and make an appearance and give input on whether the court should grant a continuance or not.

And this is kind of unprecedented in the sense of making a witness almost a party to the case. This does not happen in any other criminal cases at this point in time. What's really worrisome for us is the fact that we could have clients who are in custody and waiting for their trial, unable to post bail.

And their cases usually will get priority over people that have posted bail because these people are waiting in jail for their cases.

But with this type of language in the Bill, their cases could be moved aside so that priority is given to a case involving a child witness or some other type of situation as outlined in this Bill.

And we feel that that could end up being quite unfair to those individuals that can't post bail and are waiting for their trial. You know, we've outlined a couple of other things dealing with the lack of definitions of good cause, adverse impact, substantial adverse impact.

Things of that nature, I think, have to be clearer before you could move this Bill forward. Now, you know, we do understand the concerns for child witnesses. And I can tell you, as someone who's been in the courtroom for 30 something years, I personally take great care when it comes to having to cross child. Yes, thank you.

Okay. I'm sorry, I tend to go over. Thank you.

It's only twice as long as I normally allow, so thank you. Next. Office of the Prosecuting Attorney, County of Kauai in opposition. Anybody from Kauai? Next up, Department of Human Services providing comments. And I don't have anyone else. Anybody else wishing to testify for SB200, come on up. Angela.

Angela Melody Young work here is testifying in strong support. So this will expand statutory provisions for minor protections under Chapter 806. So where it says. It basically says protect minors in court, provided that no more than three continuances shall be permissible by either party unless good cause is shown.

So Roy Cares proposed amendment is to unlimit the continuances because there's no need for this sentence to limit it to three continuances because then that be seen upon the fourth continuance, then they can put undue burden upon the minor. Right. So unlimited amend language also to be more inclusive of protected classes under the Constitution.

So amend Chapter 5604 and 806. Although this does not involve minors and just adult defendants. Right. As per the federal constitutional rights. If you don't amend it now, it's a very inefficient process to wait for the next year.

So Amendment for subsection 2, substantial adverse impacts upon victims and witnesses should list protected classes with vulnerable health conditions to create a level of health equity for disabled victims and disabled witnesses because all disabled citizens are protected by the federal Constitution.

And so this law is trying to be considerate of persons who will have the worst effect because of trial due to health reasons. Right. And cannot stand trial like a normal person. So disabled people, which is our amendment. And also to expand the statutory provisions for minors. And also I.

This is a personal opinion to list senior citizens to stand trial because for further provisions you'd want to be nice to seniors. And although seniors are not federally protected by the Constitution, I think it's something good to list in there. Thanks.

Thank you, Angela. Anybody else wishing to testify in SB200 Members? Any questions? Come on up.

Yeah, just a couple of things. I understand your concern with with this bill, and I'm reading some of the stuff from the prosecuting office. Maybe the Bill is not what you think in the intent is, but this bill was put together from victims and victims families.

I understand you've been there a long time and you've seen a lot of things, but this is the eyes of the families and the victims within my community and other communities that came to me since I've been in this square building.

So what would have been good for us to have you guys and even the prosecuting is how you could make this Bill better than just going against the Bill because the victims out there are still watching, still paying attention. They're really watching this Bill.

So instead of just giving the part about what is not good about the Bill, that you could have gave a little bit input on what we can correct because we always have another time to have this Bill heard. So what I would have want from the prosecutors and you. My prosecutor has some good stuff.

But from you guys, how is this gonna actually protect the victims? I'm going for.

Okay. Okay. Thank you very much. Any other questions? No comment. Okay. Okay, thank you.

I mean, I'm willing to answer.

You're willing to answer? Okay, please. I didn't know that there was a question there, but go ahead.

That was a question.

That was a question.

Our role is a little different in the situation because of what our duty is. And our duty is to protect the interest of our client.

And Our real concern is that a person who is, as I said, sitting in custody, waiting for their trial, and the case is ready, and then their case gets moved off for a different case because it's reprioritized under the Bill for us, that's unfair.

Now, we do understand the situation with victims, especially with children, but I cannot say to you what can be done to make it better or easier for them. It's a very difficult situation. I think a lot of care has been done up to this point dealing with other issues with child witnesses.

But as far as the time that goes into a case, a case is only ready to go to trial when the case is ready to go to trial, unfortunately. And we don't delay things, you know, on purpose because we don't want to have the child testify or anything like that.

I think great care is given by our attorneys.

Thank you very much. Thank you very much. Before. Move on. Where's my. Make enough copies for everyone here. Okay, moving on. SBA relating to jury duty. First up, we have SBH HPAN, HI, Associate of Professional Nurses, in support. Are you present? Jeremy Kleitmore, not present.

On zoom chair.

Okay, next up, we have Jamie Bowling, APRM, testifying for Optimum Health and Wellness Hawaii, and support. Dr. Scott Kauai, provider shortage crisis task force and support. 1234567 and eight other individuals in support. Anybody else wishing testifying? SBA. Okay, Angela, you got two minutes.

Angela. Melody Young, ROAR cares in strong support of this act, legislating exemptions of jury duty for APRN nurses under Chapter 612. So APRN nurses have a full practice authority and provide primary and specialist care to the elders, senior citizens, and disabled persons. APRNs have advanced clinical training and are nurses who provide direct patient care.

So even if it's not automatically exempt, some nurses are able to request an excused absence from jury duty if the work schedule creates a significant hardship. But it's good to be technical because nurses are an emergency health professional. So it could also be very considerate of registered nurses as well. RNS.

So my proposed amendment is Chapter 6126 subsection 2. An actively practicing physician, advanced practice, registered nurse, and registered nurse. Because RNs are also licensed and work in hospitals, clinics and schools and monitors patients, teaches them about their health, and performs medical procedures.

So to be more inclusive with the statutory provisions, you could put APRN and RN and also RNs practice under the supervision of a physician, while APRNs have more autonomy and responsibility. But both nurses are needed. Okay, thank you.

Thank you very much. Okay, anybody Else wishing testify in SBA. Okay, come on up. Dr. Lewin.

Hello. Joyce Ann Buenaventura, Vice Chair Aquino. And numbers. Very briefly, just want to say that. You need to identify. Zero, Jack Lewin, the Administrator of State Health Planning and Development Agency. Just want to say very briefly, we're very much in support based on the workforce issues, and I think this would be a good move.

Maybe we'll be lucky enough in two or three years that it won't be necessary, but certainly is now. So thank you very much for the opportunity to testify.

Okay, thank you very much. Anybody else wishing to testify in SB8, come on up. Identify yourself.

Good afternoon, Chair. My name is Elizabeth. I'm with the Hawaii. Zero, nope. Disability Communication Access Board. Decap. Yes. My apologies. We are testifying in support. We apologize. We didn't get any written testimony to you. Our board voted this morning. So we are in support of this. Bill as we acknowledge that advanced practice.

Sorry, APRNs are definitely in shortage and therefore it'd be essential to be able to be reporting their job and on jury duty.

Okay, thank you very much. Thank you. Anybody else wishing testify in SB number eight? Zoom. Anybody there? Members, any questions? Okay. Senator Keokolole.

Thank you. Chair, for Dr. Lewin.

Dr. Lewin, come on up.

Do you have any data on. How. Much staff time or is lost from jury duty or appointment time or any data at all to indicate that this is going to make any difference in patient outcomes or care?

Thank you for the question, Senator. Don't have data. I do have experience personally with having to serve jury duty as a practicing physician here in Hawaii in years past. And it's just a difficult thing when there's a shortage. Not as difficult for. For urban Honolulu as it is in neighbor islands and rural areas, obviously.

But I think that we have such a shortage and there's so few of these advanced practice nurses available to us these days that we think at Shipta that we really need to protect them from a potential two week or three week absence from their employment.

Okay, thank you, Chair.

Okay, stick around. I have a question. zero, yes, okay. So in healthcare, I do know that there are a number of APRNs, especially those who have just graduated, graduated, who are not actually practicing. My concern is that this is a blanket exemption by just having an APRN title and not actually being in the work course.

So like you had stated, where there's a shortage. Now, I could see that especially for practicing APRNs, but non practicing ones, just by having a title, I don't see a need for it. For it Especially since we need to continue to have a jury pool and not just give out exemptions to everybody who could afford a title.

Do you agree?

I. Doctor, thank you. And I also think that we might want to put a time duration on this in terms of hopefully that we're going to recruit more advanced practice nurses in our state going forward.

Okay, thank you very much. Okay, anybody else with questions? Moving on. Okay, next up, we have SB144 relating to chiropractic. First up, we have Hawaii Board of Chiropractic, Rochelle Araki providing comments.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Rochelle Araki, Executive officer. Where the Board of Chiropractic. The board stands on its testimony providing comments. Thank you for the opportunity to testify.

Okay, thank you very much. Next up, we have Hawaii State Chiropractic Association in support. Dean Shivers, come on up. Dr. Shivers.

Hello, my name is Dr. Dean Shivers. I'm President of the Hawaii State Chiropractic Association and I also own seven chiropractic clinic here in Hawaii.

We support this Bill because we think it'll help bring more chiropractors to the island, which we're short on, and also bring qualified chiropractors because they would have had hands on time with real life patients instead of just at school. And then we're also one of only five states that doesn't currently allow this.

I think that's why it would be good for the chiropractic profession and the patients in Hawaii. And I'm happy to answer any questions if you having. Thank you.

Okay, thank you very much. Okay, next up, we have Hawaii State Chiropractic Association, Jo Leonardi and we have 57 other individuals all in support. Anybody else wishing testify on SB144? zero, I missed one. Okay, I'll go that. That one. Next. Thank you. Anybody else wishing testify on SB144?

Yes. Chair Angela Melody Young, testifying on behalf of work here is in strong support to lower the standards for student chiropractors. So statutory provisions for a student to become chiropractic.

Lower the standards.

zero, okay. Okay then. Okay then. To be inclusive of students to practice.

Under the license, chiropractic students to engage in clinical practice as part of their college instruction. Zero, okay. It doesn't say anything about lowing the standards, so please.

Okay, so it doesn't lower the standards of like the health care so that they can provide.

I'm sorry, I not argue. But testify as to the Bill and not to something else.

Sure. From my understanding of it Maybe I was having a. Like a. Not the most accurate interpretation of it, but to expand the statutory provisions then for practice. Practicing chiropractors and student chiropractors. Okay, I'll rephrase. So chiropractors treat back pain, neck pain, headaches, joint pain, minor neck or spine injuries like whiplash, and chronic conditions like osteoarthritis.

And they perform spinal manipulation to use hands to adjust the spine, and soft tissue therapy such as various techniques to treat soft tissue. And chiropractors use heat, Ayes, electrical stimulation and exercise and nutritional counseling. And it's a. Alternative medicine, so it's considered a type of complementary and alternative medicine. And chiropractors are not medical doctors with mds.

But if they're are to be more statutory provisions for students within the chiropractor profession, then it is a good idea because alternative methods of practice should be supported. Thank you.

So it's you providing comments then, and not in support or in support. Okay, any. Okay, thank you very much. Anybody else wishing to testify in SB144? Members, any questions? Okay, seeing that I. My Clerk told me I missed the Bill. I apologize. SB107 relating to medical informed consent.

First up, we have Chelsea Fukunaga, Hawaii Medical Board, in opposition.

Good afternoon, Chair, Vice Chair, Members of the Committee. My name is Chelsea Fukunaga, Executive Officer for the Hawaii Medical Board. The board will sign on its written testimony in opposition of this Bill.

Thank you. Thank you very much. Next up, we have Queen's Health System. I see JC Mikulanek providing comments.

Chair, we'll stand on our comments here for answering questions if you have.

Thank you very much. Next is Hawaii Healthcare Association of Hawaii providing comments? Paige, please proceed.

Thank you, Chair. We'll stand on our submitted comments with some concerns about the duplicates implicative nature of some of these standards potentially. Thank you.

Paige, I know who you are, but please identify.

Zero, of course. Paige Choi with the Healthcare Association of Hawaii.

Thank you, Chair. Thank you very much. And same thing with jc I know who you are, but please identify yourself for the record with Queen Cell sister. Thank you, J.C. okay, thank you. Next we have Hawaii Medical Association, Elizabeth Ignacio providing comments. Anybody else wishing to testify? SB107.

Okay, Angela, in support or identify yourself and say in support or not position.

Angela. Melody Young is strong support. So I'm not a medical professional, I'm not a Doctor, but my dad was a Doctor of a public government hospital in China in Shenzhen, and my grandmother was a PCP in the Chinese Cultural Revolution.

So some of the medical language may not be as fluent for me, but I'm going to try my best to explain things from this perspective. And if I'm inaccurate, I apologize in advance. Thank you. So according to this, this is an amendment to the Hawaii Medical Board chapter.

So instead of May, it's a shout that they must create these standards for practicing health care providers. Right. And what must they elevate their standards for? So, for example, to perform medical procedures and diagnostic tests. Right. And so I will provide a very specific scenario. Okay.

So the amendment would be under 671 3B, subsection 1, the condition to be treated. My proposed amendment involves a primary condition and a secondary health condition, because right now, as the law is, it is not inclusive or consideration of a primary and a secondary health condition involving a mental health and a physical health condition.

For example, if a primary health condition needs to be treated with a diagnostic procedure and the patient has a secondary condition and it may exacerbate underlying mental health and physical health symptoms, the condition requires knowledge of a combination of mental and physical health factors.

The doctors from the mental health and the physical health professional field must integrate the knowledge to provide appropriate care. So you have to be technical, I think, from this perspective, because doctors will be like, zero, we're too busy to call.

Thank you, Angela.

Okay, thank you.

There may be questions. Okay, thank you. You can ask me. Anybody else wishing to testify on SB107 Members, any questions? Okay. Seeing none. Moving on. SB189 relating to breast cancer screening. First up, we have Department of Health providing comments. Next, we have DCCA Insurance Division providing comments. Okay, thank you. Next we have HMSA Don Carriso providing comments.

Okay. Not here. Okay. Next we have Hawaii Medical Association in support. Elizabeth Ignacio. Next, we have Hawaii Radiological Society in support. Next we have three other individuals in support. Anybody else wishing to testify in SB189? Okay. Come on up.

JC Mike Dunlich. On behalf of the Queen's Health Systems, I think we submitted late testimony in support of this measure and certainly appreciate the introducer putting this forward. Queen's on an annual basis, provides about close to 34,000 screenings across the system. This Bill adds to identifying and, and hopefully eventually effectively treating breast cancer. So we support it.

Thank you.

Okay, thank you. Anybody else Wishing testify on SB189 Members? Any questions? Insurance Division. I have a question. So I actually looked up what you said. That current guidelines developed by the American Society of Clinical Oncology is not consistent with hrs section 423e. 1.4. Try look it up.

Yes, that is our medical necessity statute.

Okay. There is no chapter 423E.

Zero, I'm so sorry, Chair. It is 432E 1.4.

I believe I looked that up. Okay. Under 432E. Under. And I did not see anything there.

Okay. We can get you a copy of that statute.

Okay. We have. Okay, why don't you do that? Because we are going to defer decision making until another date. And I looked up that chapter and There is no 432e chapter in the Hawaii Revised Statutes. Not online and not on the black.

I apologize books that we have.

Okay. Zero, while you're still there, I have a question. What do you mean by defrayment provisions?

Okay. Under the Affordable Care Act, there is a set of benchmark plans and 10 essential health benefits that are covered. If there are benefits that are passed by states that are in addition to the EHBs, states might be required to defray some of that cost.

That means the state ends up having to pay for it if we do not. If we do not comply with 45 CFR Section 155.170, there may be requirement for defense.

Frame it for that group of population which includes the individual marketplace.

Okay. I'm sorry, you don't look like Gordon Ito. So could you please identify yourself?

Arlene Ike with the Hawaii Insurance Division. Your name again? Arlene Ike. Arlene Ige.

Okay, one other question. Okay. Normally when we increase beyond the essential health benefits, we would do a sunrise analysis. If we have a sunrise analysis for additional mammograms, would that comply with 45. And it basically said that this is considered an essential health benefit within 45 CFR.

Would that prevent us from having to defray the cost of additional stuff?

The sunrise analysis may help to have a better. Have us have a better understanding whether it may be considered a new mandate and subject to the defrayment. There are some studies within the state auditors reports that do examine that aspect.

Do you know whether or not the State Auditor looked and did a sunrise analysis on this yet?

We did look at the previous Bill that was studied in 2021. I think. I believe there is an affirmative statement that it would be considered a new mandate. A new mandate in their summary. Okay, 2021. 2021 study of a different measure, but.

It refers to additional mammograms.

Additional mammograms. And it was a reference also in the Bill as well.

Okay, thank you very much. Okay, wait a second. Okay. Do you have a question as to her or otherwise we'll ask someone else. Okay. So stick around. Senator Favela.

Okay. zero, yeah. So just, just curious, for the demographics that you talk about for the screening, what is the demographics for Polynesians or Pacific Islanders, Asian community in the State of Hawaii, what is the demographics that you guys have for coverage? Because last time you get not you, but previous people, that was before us.

The demographics that they talk about is not Hawaii demographics because we don't have a study.

The reason why this came up and the reason why I introduced it again is because those are the underserved community when it comes to age because they're not in the 30 age bracket and they don't have any signs of cancer, it doesn't cover them.

But we're having and knowing we're having now because of our environment, we're having more people under the age of 30 that is getting these breast cancer and stuff like that.

So that's the reason why I just wanted to know if you guys have or if you guys don't have a study to know the demographics, anything to do with Pacific Islanders, Indian, Asian Pacific, you know, community under 30 in the State of Hawaii.

Senator, we don't currently have a study on that, but we could also look up information that might be available out there to help inform on that.

It could also be where if that that could be placed into a Concurrent Resolution for State Auditor to also analyze that, that might be helpful to get a better understanding of our local demographics.

Okay, thank you very much. J.C. I see you nodding or shaking your head. Come on up. So what is your understanding about the 2021 audit report?

It was my understanding that the findings were that it would have minimal impact in terms of cost to the state or to the insurers to cover this. It's a small population. So that was the basis for our testimony.

And certainly if you're getting people screenings early on, that prevents them from having to go through cancer and really intensive cancer down the road, which saves all of us heartache as well as resources.

Okay, thank you very much. Any other questions? Okay, seeing none. Moving on. SB 191 relating to energy assistance. First up we have DCCA Division of Consumer Advocacy providing comments.

Chair, Vice Chair Members speaking on to DCCA wouldn't stand on our.

Okay, thank you very much.

Next we have Leo Asuncion, PUC and support Members of the state, Leo Sunshine, Chair of the PC who stand on. The written testimony and support providing some comments.

Okay, thank you very much. Next we have Louis Salavera, Director of Department of Budget and Finance, providing comments. Okay. Next we have DHS Director Yamane providing comments. Are you present, Director Yamane?

Not present. On Zoom Chair.

Okay. Okay, thank you very much. Next we have Hawaii Energy in support. Carolyn Carl. You don't look like Carolyn Carl.

Chester Carson for Caroline Carl for Hawaii Energy.

Okay, thank you very much. Next we have Noel Kakimoto, Hawaii Electing Electric, providing comments.

Good afternoon, Chair, Vice Chair and Members of the Committee. My name is Noel Kakimoto and I'm testifying on behalf of Hawaiian Electric. Hawaiian Electric strongly supports the intent of. The Bill, but offers comments and concerns for the reasons set forth in our testimony.

Hawaiian Electric has been a collaborative Member of the state LIHEAP working group in developing a complimentary state run utility assistance. Program for the federal LIHEAP program. And we respectfully request that the Committee considers the working Group's proposed Bill, SB994 and insert the contents of SB994 into SB191.

We stand on our written testimony and I'm available for any questions. Thank you so much.

Okay, thank you very much. Next we have pacs Foundation. Kamya Machika, are you present?

Aloha, Chair. This is Jade Mcmillan on behalf of for the Tax foundation of Hawaii. We have submitted some comments on the measure. We'll stand on our written comments. Thank you.

Okay, thank you very much. Next we have Catholic Charities, Betty Lou Larson and support anybody else wishing to testify on SB 191. Members, any questions? So I have a question of PUC. Could you come on up? Did you hear Hawaiian Electric's suggestion of basically inserting SB994, which is their LIHEAP working group, into the contents of SB 191?

Yes, we would be supportive of that.

You would? Okay, thank you very much. Any other questions? Seeing none. Do we need to recess for decision making? Okay, we're gonna move. We're gonna move directly to decision making. Okay.

First up for SB200, sheriff's recommendation is to defer this due to unintended consequences of basically favoring one set of victims over the other set of victims, not for different crimes. I believe we're not ready yet with this Bill regarding trying to fast forward any crime with child witnesses involved or disabled witnesses.

As such, we can need to defer because it's not ready yet. Thank you. Next up for SB8, I'm going to defer this until the next hearing. We are going to take Dr.

Lewins concern into account and make it like a five year pilot project, especially since we cannot just give out exemptions, but we do recognize the medical shortage. Okay, so for next hearing, that would be January 29th at 1pm and I have Senator Hashimoto here.

So next up for SB107, we're going to defer this as it's duplicative of what's already in law. So SB107 is deferred. Next we have SB144. Sheriff's recommendation is to pass this with DCCA's proposed amendments and delayed implementation. Any comments, questions, concerns? Seeing none.

Vice Chair for the vote. Chair votes aye. Okay. Thank you very much. Sample 144 recommendation is passed with amendments. Okay. Chair votes. Aye. Vice Chair, both sides. Senator Hashimoto. Aye. Senator Kyokolole San Frivella. Aye. Recommendation is adopted.

Okay. For SB 189. Chair's recommendation this one. We're just going to defer this to the next hearing. I'm going to need to look at that prior audit report. We. We take into account Senator Favela's concerns about the risk factors for certain demographics, and we got to see what the report says. Okay.

So we're going to defer to the next hearing on 1-29-25 at 1pm for decision making for SB 191. Chair's recommendation is to pass this with amendments. We're going to insert the contents of SB994 at a defective date and otherwise remove the contents in lieu of SB994. Any comments, questions or concerns seeing none.

Vice Chair for the vote. Senate Bill 191. Recommendation is passed with amendments. All Members are present. Any reservations, any notes? Recommendation is adopted. Chair.

Okay. And we are adjourned.

Thank you very much.

SA.