House Standing Committee on Health

Good morning everyone. Thank you for coming to this Joint Hearing on the committees on Health and Committee on Human Services and Homelessness. I'm Chair Greg Takayama for the Health Committee and pleased to welcome Chair of the Human Services and Homelessness Committee Chair Lisa Marten. We have a 8:30 agenda with three bills on it.

So let's begin with the first bill which is House Bill 1462 relating to crisis services. And first up we have see Mike Lambert, Department of Law Enforcement.

Good morning Chairs, Vice chairs, Member of the Committee, Mike Lambert, Director nominee for the Department of Law Enforcement. We stand in strong support of this bill. In lieu of meaningful crisis services, law enforcement will be forced to utilize arrest procedures which may not be appropriate for someone experiencing a mental health crisis.

The goal would be to divert individuals that could benefit from a behavioral health service before needing the need for something more extensive such as a mental health evaluation. I think on the west side Waianae Comp only has one bay for that type of critical support.

So it'd be very important to have lesser services available for someone that could benefit. I'll be available for questions.

Thank you and nice to see you in civilian attire. Thank you. Community Alliance on Prisons Kat Brady.

Good morning Chair Takayama, Chair Martin and Members of the Committee. Kat Brady testifying in strong support of this measure for Community Alliance on Prisons. We're really happy to see this second site named in Waianae. There is a pressing need there and we're really happy to see that happening. Unaddressed behavioral issues drive many people to incarceration.

Diverting people contending with behavioral challenges to appropriate programs is a much better solution than incarceration. Mahalo Nui for hearing this bill and we hope the Committee supports it.

Thank you. Let's see. We have written testimony from several other organizations and individuals. So let me ask at this point if there's anyone else wishing to testify on this measure either in person or oh, please step forward and identify yourself.

Good morning Chairs, Members of the Committee, I'm Courtenay Matsu, the Medical Director for Department of Health, Adult Mental Health Division. We stand on a written testimony in support for this bill. We appreciate the legislators support of bhccs which we have are current one center in Eviley.

We do note that additional funds would be needed to add to the department's operating budget to enable continued implementation statewide and on the island of Oahu. Thank you. I'll be available for questions.

Thank you. I don't have a copy of your testimony so could you please submit a copy to our Committee Clerk?

Will do. Thank you.

We'll provide you a email. Thank you so much. Anyone else wishing to testify on this measure? If not, Members questions?

Chair Marten.

For the Department of Health. Please. I wonder what kind of lead time you need to set something up like this. I assume you have to find a site and maybe do you know some permitting etc. So what kind of before there's actual need for funds to run a crisis program. Like what kind of lead time does it take?

I could give you for example with our current Iwiley site in terms of the length of time we were fortunate in that sense that we worked with the city and they actually had a facility available for us. We did need to do some renovations to the site in particular because it's a crisis facility.

We wanted to make sure we had the ability to manage behaviors that might be aggressive and dangerous. So we needed to add a padded room to the facility. That took a lot a very long time because the only we had to order it from the mainland.

There is nothing here on island and so it took a while for it to be constructed and then shipped over and then installed. I would estimate-- we are fully functioning now.

A year after we got a hold of the facility and started our repairs to it we were able to take folks but unfortunately we weren't able to take the very aggressive ones because we didn't have the padded room available at the time.

Within the past month we've had started to take it and we're hoping our numbers go up on the MH1s.

Can I ask you while you're up there, what would be the estimated cost of a second site on Oahu?

So currently we are actually in have a consultant that is doing looking at our whole crisis system throughout the state and part of it is to look at where within the state would be very cost efficient as well as needed for us to either build a crisis center or perhaps partner with certain facilities that may already be providing some types of service but to include on the crisis chairs.

So I would say that the cost would vary depending on whether it's a freestanding facility or it's going to be an add on to an existing facility. With the current BHCC in Iwiley I think the cost was about we put it in our testimony our budgeted cost was about 4.3 million.

Now that keep in mind that does not include rental of the space because we were able to have that partnership with the city and it didn't include the startup costs like the repairs and all that.

Okay, thank you.

Thank you.

Any other questions? If not, let's move on to House Bill 700, relating to cognitive assessments. First up, we have Executive Office on Aging, Caroline Cadirao.

Good morning, Chair Takayama, Chair Marten, and members of the committee. Caroline Cadirao with the Executive Office on Aging. We support the intent of House Bill 700 and we offer comments. We all are in agreement that cognitive assessments are necessary. This bill is mandating healthcare providers to provide the cognitive assessments.

It's requesting data that would need to be HIPAA compliant and it would require EOA to secure the data, so we have a few recommendations. We wanted to ask that the bill be amended to offer cognitive assessments. We ask that the bill create a pilot project so that we can demonstrate viability for a statewide program.

EOA is requesting flexibility to identify those data elements to ensure privacy and secure obligations. And we also request that--we had some amendments to the actual bill itself that we had attached, so, for clarity. So thank you for the opportunity to testify and I'm available for questions.

Thank you. Department of Health.

Good morning, chairs and members of the committee. I'm Wanda Anae-Onishi with the Department of Health. We also stand on our written testimony in support and defer to the EOA for comments. Thank you.

Thank you. Let's see. We have the State Health Planning and Development Agency, SHPDA.

Aloha, Chair Marten, Chair Takayama, and honorable members. I'm Jack Lewin, Administrator of SHPDA, advise to the governor on health innovation. We're in strong support of the bill. However, we also believe that this--we agree with EOA that this needs to be tested and understood better.

We don't think it should be mandated, obviously. We think patients should be able to refuse such an examination, but on the other hand, we think that they're offered woefully too, not often enough today, so what we'd really like to see is that the payers make sure that these visits when requested by the ohana patient or physician are compensated for, and I think that would be the kind of practical approach to this.

We also want to defer to the issues that Med-QUEST may have in terms of this, in terms of their program. They probably have federal rules that need to be considered here. So thank you for the opportunity to testify.

Thank you, Doctor. Alzheimer's Association of Hawaii, Coby Chock.

Aloha, Rep Takayama, Chair Marten, members of the committee. Coby Chock with the Alzheimer's Association, standing in strong support of this measure. The cognitive assessment testing is so critical at this time. At one point there were no treatments for this disease. You get the disease and you kind of just wait it out.

Only in the past few years there have been disease modifying treatment breakthroughs that allow people to be treated much earlier--or if people are treated earlier, delay the progression much sooner. With that, it requires something like this for us to cement early detection in regular visits for patients.

We will defer to EOA and the Department of Health on the data transmission. We'd just like to point out that in this requirement currently, there is an opt-out provision, so it's not requiring the patient to do this regardless of what they choose to do, but this is a provision that allows or requires it to be done on a standard basis with the patient being able to choose not to do it rather than having to ask the doctor to do it because many patients don't even know what this is.

We have testimony from some of our advocates and one of our advocates is--wanted to remain anonymous for privacy reasons for their family. We have comments here from them that I'll provide with your committee clerk after, but thank you for your time.

If you can provide that to our committee clerk? Healthcare Association of Hawaii, Paige Choy on Zoom.

Morning, chairs, vice chairs, members of the committee. Thank you for the opportunity to stand on our comments. I want to echo what SHPDA and Executive Office on Aging commented on in their testimony, both written and verbal.

We would be happy to work on this as a pilot, I think discuss some of the issues that were raised in our testimony, especially regarding the burden on providers of this reporting and the safe and secure transfer of the information.

I will also note that the Healthcare Association of Hawaii runs education events for our 170 members and we do often open it up to providers outside of our membership, and we would be very, very happy to partner with the Executive Office on Aging and the Alzheimer's Association to offer the kinds of education for providers about what tools and treatments are available. So we do look forward to the continued conversation and thank you again for the opportunity to stand on our comments.

Thank you. Let's see, also on Zoom we have Anthony Vericella, Alzheimer's Caregiving and The Caregivers. Please proceed.

Aloha, Chair Takayama, Chair Marten, and members of the committee. Thank you very much for this opportunity this morning, and I stand--and our organization, which is a 501c3, started in September of 23, focusing on helping caregivers of loved ones who have Alzheimer's and related dementias--stand in strong support of this particular measure, and reiterate as Coby indicated from the Alzheimer's Association that there currently is an opt-out so nobody's being forced to do this, but it's more on the reverse side, and that is the providers, as Paige is indicating, the providers themselves at all medical fields--medicine, dentistry, eye care, etcetera--believe it or not, have very little knowledge or experience throughout the islands with actually working with people that have Alzheimer's or let alone the early detection of people having Alzheimer's.

So the standardization of cognitive assessment tests is a big step and one step forward in the process, and what we certainly need is for the whole medical system to better understand patients that have Alzheimer's.

I can tell you here on the Big Island, where we're spending most of our time caregiving for my wife, who now has had Alzheimer's for six plus years and is in the middle to late stages--hasn't been able to do any aspect of daily life for more than four years--finding medical practitioners in all areas to actually work with us and work with her is quite difficult.

And I know it's more difficult on the neighbor islands than it is on Oahu, but it is also difficult throughout the Island of Oahu. So standardization of cognitive assessment tests, one that allows the patient to opt-in if they choose, is a really important step, as Paige, Office of Aging, and others are indicating.

Yes, there's a lot of other data research that needs to be done, there's training that needs to be done at all levels, but we can't wait any longer. There's at least 30,000 people in Hawaii with Alzheimer's or related dementias. There's probably at least three caregivers per family who are actually aiding in the caregiving.

Thank you.

So there's nearly 100,000 people affected.

Thank you, Mr. Vericella.

Thank you very much.

Okay, that's all the testifiers I have listed. I do have written testimony from about a dozen organizations and individuals in support. So with that, is there anyone I missed? Oh, please step forward.

Thank you. Daintry Bartoldus, Executive Director for the Hawaii State Council on Developmental Disabilities. I apologize. We did submit late testimony on this. We're in strong support of the intent of this measure. We definitely agree that early detection is very important. However, age 65 we don't feel, is an early detection, and we request that that be removed, 65 or older.

Individuals with intellectual and developmental disabilities--onset, such as for people with Down syndrome or autism or fetal alcohol spectrum disorder, happens in the early 40s and 50s. Individuals with traumatic brain injury, a stroke, happens in the 50s. So we just respectfully request that you remove that age 65. We don't feel that is early detection when it's happening at the age of 40. Thank you so much for this opportunity to testify.

Thank you. Anyone else wishing to testify? If not, members, any questions? Oh, I'm sorry. I didn't--I was--please step forward.

Cynthia Bartlett, just a mother. I have a child that's 31 with Down syndrome and her psychiatrist did say that dementia is very, very strong possibility for them by the time they reach 40, so I just wanted to support what Daintry just said.

Thank you very much. Members, any questions? If not, for Office on Aging, Caroline Cadirao, quick question. In their testimony, Alzheimer's Association suggests a cost of about $150,000 for such a pilot project. Would that be in the ballpark?

For a pilot, that would be in the ballpark because we're thinking we could possibly contract it out, and I think the part where it may get more costly is in securing the data, but for a pilot, 150,000 would be in the ballpark, but something more full-blown, larger. Thank you.

Thank you very much. Let's see. If there are no other questions, let's move on to HB 237, peer support programs. Department of Health. In support. Thank you. Let's see. Department of Human Services offering comments. Commit to Keiki, Jared Ellis in support. Family Hui Hawaii, Cherilyn Shiinoki.

Good morning, Chairs and honorable Members. Thank you for the opportunity to testify. My name is Cherilyn Shiinoki, and I'm the Executive Director of Family Hui Hawaii, a nonprofit strengthening families organization that has been providing peer to peer support since its incorporation back in 2012. And continuing the legacy, the 28 year legacy of the Baby Hui, which did that prior. The Baby Hui was funded by the Department of Health and Department of Human Services.

We stand by our written testimony and would like to highlight one thing about peer to peer supports, which is the really smart investment that you make in these relationships. Because when these families are in these programs, their relationships are so strong and they're built really fast because nobody understands what you're going through like a peer.

And these relationships last much, much longer than the programs themselves. So while you invest in the programs initially, those families start to create a network of support for each other that can last throughout adolescence. I think we have many testimonies from families that were submitted and we have many, many more. Lots of families we have heard still connect with their Baby Hui or their Family Hui families from when they were born. Many, many stories of when they are now going to prom together. They've stayed in touch with each other.

And so this is an opportunity not only to just invest in those initial direct services, it's really an opportunity for you to involve our community to take take action and strengthen each other so we're not depending on institutional support forever. We're giving them the capacity to leverage those initial dollars to continue that support throughout their lives. So thank you so much for your consideration on this important bill.

Thank you for being here. Johanna Nielsen.

Johanna's kids are really sick with the flu, and it's just another example.

I know what that's like. Thank you. Samuel Barringer in support. Oh, yes.

Hi, Board. Thank you for the opportunity to speak today. So this will be a personal testimony in support of the bill. My name is Samuel. I'm a military child, the oldest of five boys, and a senior at Punahou School. I'm here on behalf of my family in strong support of peer to peer support programs.

I was born at Tripler Army Medical Center 18 years ago. Everyone that knew my parents at the time will remember that I started crying at 3 weeks old and didn't stop until I was 3 months old. And as first time parents, my mom and dad didn't expect or know how to handle a colicky baby.

And I was always crying. My parents spent many of their early days as parents stressed and tired and they struggled to connect with others. When I finally did stop crying, my mom set me down for a few moments and she noticed an advertisement for Baby Hui. Several months later, she joined a hui with eight other families.

There, my parents finally found connection. A group of people that understood what it was like to have a crying baby. Over the next three years, my father was away training and deployed for over 18 months. During that time, my mom continued to find community and support through the hui. It made a positive difference in her everyday life.

And through her well being, the hui made a difference in my life as well. In the years that followed, I was eventually given a little brother and then another, and finally two more. Through each of our military moves, my parents fondly remembered their experience with Baby Hui.

Although there were no such programs around them, they had learned the value of peer to peer support. They made a point to find it and use it. My mom and dad had been shown a model that gave them the tools to be the best parents they could be. One that continues to benefit our entire family.

Today, back on Oahu, my family still gathers with friends from our original Baby Hui. This year, along with the rest of the babies in that group, I'll graduate high school. I may not remember participating in Baby Hui with my parents and I certainly don't remember gracing them with my high pitched screams as a colicky infant.

However, I do know that I want to parent children in a world that prioritizes the benefits of peer to peer support. It's important to the State of Hawaii to recognize that peer to peer support programs strengthen the social fabric of all families. Any investment made in these programs will have a return that lasts far into the future for our entire island community. Again, my family and I strongly support HB 237. We hope you will too. Mahalo for the opportunity to provide this testimony.

Thank you, Samuel, for taking time to come down here, and good luck on the carnival. Let's see, we have written testimony from about a dozen or so other individuals and organizations in support. So have I missed anyone wishing to testify on this measure? If not, Members, any questions? Sure.

Sorry, I'm on Zoom. I would like to testify to this.

I'm sorry, go ahead. I missed you. Please identify yourself and proceed.

Aloha, everyone. My name is Kim Nabarro. Kimberly Nabarro. I provided personal testimony in strong support of HB 237. I serve as a peer support specialist. I've been the peer support workforce for the past 10 years and just wanted to kind of share about how, a little bit about my personal testimony.

I am a person that has battled through addiction for about 20 years of my life, and I utilize my navigating systems like having my children in child welfare or having to battling substance use disorder while pregnant and experiencing domestic violence or intimate partner violence, if you will, and homelessness throughout that.

And now I pour that experience and walk alongside those who are currently navigating those systems. And I just want to say in a program that I currently work for as a peer support specialist, I help to support individuals who are disconnected from resources that are available and that they qualify for.

And by just helping them to get connected but stay engaged and really helping them to understand the why. I think case managers and all the different supports that are available in a system are amazing. But without understanding the why or having someone to say, I've been there, this is exactly what I went through.

I know it's scary, I know you might feel judged, but let's do this together. And so walking alongside, maybe attending appointments or making phone calls with them or being able to just share in their time of need has been so helpful in that. I also want to mention that I am a parent with reunified children where my children were once in foster care.

And so being able to want to provide for my children more than just surviving the day to day, but actually helping to support and believe that my family can thrive and do what other families can do beyond just attending school, really kind of scoring highly in school or integrating ourselves within our own community or systems.

This is another thing that with your work as a peer support, I help parents to look at not just the crisis that they're in, but looking at long term support and recovery. Also as a person in addiction and that I'm in active recovery myself, I pour that into my peer support work as well so that those...

Thank you. I can ask you to summarize, please.

Sure. So I strongly support this bill, and for those reasons that as a peer walking alongside those who are navigating those systems can feel supported by that shared and lived experience.

Thank you very much. Anyone else wishing to testify on Zoom? Or please step forward. You can line up and identify yourself, please.

Good morning, Chair Marten and Takayama and the rest of the crew. My name is Christina Simmons and I work for Early Childhood Action Strategy. I did put in my testimony. You had some wonderful people who spoke at different parts of the continuum of care and support for families to keep them out of child welfare and really support the families at the base level.

I wanted to nerd out a little bit and to say that these, all this bill helps to meet the goals of the Infant and Early Childhood Mental Health Plan for the State of Hawaii. It also helps to meet the recommendations of the Trauma Informed Care Task Force. And it also helps to meet the recommendations of the Mālama 'Ohana work group that just finished their work and published around child welfare and how to improve it. So I just wanted to sort of tie all the pieces together from family supports in the community to a more formal one that Kim has been working really hard on. So thank you so much for this opportunity.

Thank you very much. I believe there is one more. Yeah. Individual. Please.

Aloha, Chairs, Vice Chairs, honorable Members of the Committee. Thank you for the opportunity to testify in strong support of this bill. My name is Leilani Novak. I'm from Family Hui Hawaii. In order to really cultivate a positive community and future for Hawaii, it really is important to offer support during the most impactful period of our future generations lives.

Research as well as the testimonies that we've heard today have really shown the long term positive effects of peer to peer support programs, not only for parents who may be struggling with feelings of isolation or loneliness, financial hardships, or other external stressors.

But for the children themselves and their physical, cognitive, behavioral, and social development. Through this measure and increasing access to peer to peer support programs, we can have a powerful and impactful positive effect on the lives of not only our families, our keiki, but our community at large. So thank you for the opportunity today to testify in strong support.

Thank you very much. Members, any... Anyone else wishing to testify? If not, Members, questions? Please proceed. Seeing none. Oh, I'm sorry.

Department of Health, please. I'm just wondering how do you target families that might be particularly high risk or how do you select families for participation?

Hi. I'm Matt Shim. I'm Chief of the Family Health Services Division. We do have several programs, home visiting, even our family planning, reproductive health, and our connections with our community partners who kind of help and guide and find those families at risk and help them get to different services available.

Any other questions? If not, let's move to decision making. We have all Members of both committees here, so first bill up HB 1462 relating to crisis services. My recommendation is that we move forward with the House draft. Defecting the date. There's a blank amount of money specified in the bill in the report language.

I'd like to note that the existing Crisis Center in Iwiley costs $4.3 million in operating costs for future committees to consider.

Also, I'd like to make an amendment on page 2, line 17 to specify that the second Oahu site shall be in an area that data shows to be affected by disproportionately numbers of individuals with mental health conditions, substance abuse disorders or homelessness. Those are my recommendations. Members, any questions, comments or concerns? Seeing none.

Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 1462. Chair's recommendation is to pass with amendment. [Roll Call] Chair your recommendation is adopted.

For the Human Services and Homelessness Committee, same recommendation. Any questions or comments? Seeing none.

Vice Chair for the vote voting on HB 1462. Chair's recommendation is to pass with amendments. [Roll Call] Chair your recommendation is adopted.

Thank you. Next Bill is HP 700 relating to cognitive assessments. Like to defect the date. Include technical amendments for clarity, consistency and style. There's a blank amount in the bill noted. I'd like to note in the Committee report the suggested cost of a pilot project would be $150,000.

Also, adopt the amendments suggested by the Executive Office on Aging, which were articulated by the Director. Members any questions, comments or concerns? If not Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 700. Chair's recommendation is to pass with amendments noting all Members present. Any Members voting no, any with reservation. Chair, your recommendation is adopted.

For Committee on Human Services and Homelessness, same recommendation.

Voting HP 700. Chair's recommendation is to pass with amendments. Any members voting no? With reservations? Chair recommendation is adopted.

Thank you. Final Bill on this agenda, HB237, relating to peer support programs. Like to move this forward with the House draft, defecting the date, blanking out the two FTE positions and the budgeted amount of $860,000 per year, and put that in the Committee report. Questions, comments, Concerns? Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 237, Chair's recommendation is to pass with amendments noting all members present. Any members voting no? Any with reservation? Chair, your recommendation is adopted.

Thank you. For Committee on Human Services and Homelessness, same recommendation.

Voting HB237. Any Members voting no. Excuse me. Voting HB 237 Chairs recommendations passed with amendments. Any voters or any members voting no? With reservations? Chair, your recommendation is adopted.

Thank you very much. This concludes our Joint Committee, and we'd like to move on right away to our 8:45 agenda for the Committee on Health. And first of all, let me take care of some housekeeping reminders which I forgot to do at our earlier hearing.

Beginning with, in order to allow as many people as possible to testify, we're going to limit testifier to two minutes each. Also, for those on Zoom, please keep yourselves muted and your video off while waiting to testify. If you're disconnected, you may attempt to rejoin the meeting.

In the event of a total network failure which has happened, it may be necessary to reschedule the hearing or schedule a meeting for a later date because we are required to be available on Zoom. Finally, for those on zoom, please avoid using any trademarked or copyrighted images because that will take us off the air.

And finally, and most importantly, please act with aloha. Refrain from profanity or uncivil behavior, which I'm sure doesn't need to be reinforced. So, first up, we have- First up, we have HB 1004 relating to uniform health care decisions. And first up, we have Attorney General's Office.

Good morning, Chair Takayama, members of the committee, my name is Erin Lai. I'm a Deputy Attorney General representing the Department of the Attorney General.

The Department of the Attorney General supports this bill as it would update and consolidate our current laws adopting the modified version of the Uniform Health Care Decisions Act, including, but not limited to, you know, recognizing the nuances of capacity and clarifying and safeguarding an individual's right to receive treatment when they're having a mental episode.

We also maintain certain features from our- from the 1993 Uniform Healthcare Decisions Act that's unique to Hawaii. And I thank you for the opportunity to testify and I'm available if you have any questions.

Thank you. Peter Hamasaki, Commission to Promote Uniform Legislation on Zoom. Please proceed.

Good morning, chairman, committee members. The commission is in support of HB 1004, which as noted, enacts the 2023 revision of the Uniform Health Care Decisions Act. Thank you for your support of this measure.

Thank you very much. Let's see, that's all the testifiers I have. Anyone else wishing to testify in this measure, please step forward.

Daintry Bartoldus, Executive Director for the Hawaii State Council on Developmental Disabilities. I apologize again for late testimony that didn't get in. We are in support of this measure, especially on line seven. I believe it's line 18, page seven, line 18, where it talks about supported decision making. We're very excited to see this in here.

Supportive decision making is extremely important that goes along as alternative to guardianship as well as in conjunction with guardianship. So an individual is allowed to be a part of their decision making. So thank you very much for this opportunity to provide testimony.

Thank you. Anyone else wishing to testify, please thank you very much. Last call. If not Members. Questions? Seeing none. Let's move on. HB 1282 relating to certified caregivers. First up, we have Hawaii State Department of Health offering comments. Stand on your comments. Okay. Hawaii State Council on Developmental Disabilities.

Thank you. Daintry Bartoldus, Executive Director for the Hawaii State Council on Developmental Disabilities. We are in strong support of this measure. Individuals 18 years old, these are family homes where the children actually grow up with the residents in their home. They know them the best and they're very capable of looking after these individuals.

Instead of going to the mainland to find a job, they can stay at home and help their family. These again are family care homes. On a personal note, I take care of a person who's 86 years old.

My 16 year old neighbor will come over and watch her for me when I have to go to the market and get something much better than his 21 year old sister who will be on her cell phone, can buy cigarettes and alcohol and do other things. So I don't think the age 21 makes the person.

Everyone is maturity level is different. So I really am in strong support of this. Thank you so much.

Thank you. There being no other testifiers. Members, any questions? Seeing none, let's move on. HB 1092, relating to Medicaid, third party liability. Department of Human Services.

Aloha chair, members of the committee. On behalf of Director Yema, we stand in strong support.

Thank you. I believe this is your bill. Right? So okay. You do support it? Yes. Any other testifiers? If not, members, questions?

If not, let's move on. HB 1379 relating to international medical graduates. Excuse me, Hawaii Medical Board.

Good morning, chair, vice chair, members of the committee. My name is Chelsea Fukunaga. I'm the Executive officer for the Hawaii Medical Board. The board will stand on its written comments off our written testimony offering comments. And I just want to clarify that this is the official testimony for the board. Any other testimony that's represented,

it's not the board. That's their personal opinion. Thank you.

Okay. Anyone else wishing to testify? We have written comment testimony from several organizations. Please step forward. Dr. Lewin.

Aloha. Chair Martin, Chair Takayama, honorable members, Jack Lewin from State Health Planning and Development Agency. This bill would really accelerate recruitment of physicians. It's strongly supported by the Philippine Medical Association and others. We do have some concerns that we would like to add to it. There- There's mentioned there's a world directory of medical schools.

It would be good if that- that was listed as the origin school was in that- that group of schools which have some more reliability. We also believe that the candidates should have a minimum of two years of higher level clinical training. Really defer to medical board and DCCA, Hawaii Medical Association and others in terms of their comments.

But we wanted to add these and think that if we can make this work out, it would certainly be a positive thing for our workforce shortage. Mahalo.

Any other testifiers? Seeing none. Members, questions? Seeing none. Let's move on to HB 1389. Control of Feral Chickens. First up, Department of Health.

Morning. Chair Takayama Co Chair, Vice Chair and Members of the Committee. My name is Matt Carano, Department of Health, Environmental Health Services Division. We support this. It passes money to the counties to do feral chicken control. And we'll be willing to do a public education campaign should this get funded as well. Here for any questions, stand on written testimony. Thank you very much.

Thank you. DLNR Department of Land and Natural Resources.

Aloha. Chair, Vice Chair, Members of the Committee. My name is Jason Omick with Division Enforcing Wildlife, DLNR. And we stand by our written testimony in support available for questions.

Thank you. Anyone else wishing to testify? We have written comments from several organizations in support. Please step forward.

Good morning Chair, Vice Chair, Members of the Committee. Cedric Gates on behalf of the Department of Agriculture. The Department of Ag stands on its written testimony in support here for any questions. Mahalo.

Thank you. Anyone else wishing to testify? If not members, questions? I do have a question for the State Department of Health. This bill proposes funding for two programs. One, a city. A grant to the city for control of feral animals and also Department of Health Education campaign. How much are you suggesting be allocated for these?

Well, we don't have a put start. Matthew Carano, Division Department of Health. You know, there was a very similar bill last year and that was passed ultimately with funding to it and there was line vetoed. I think that would be a good place to start.

I think we have a very humble expectation for what a public education campaign could be. Just some materials from the Department of Health side. $50,000 or less was I think previously appropriated when it comes to appropriations for the city and County of Honolulu for their programs or the other counties if it should be expanded.

You know, I would kind of defer to those agencies as to what they could possibly need.

Okay, thank you.

Thank you. Now let's move on. Next bill up we have HB 1109, relating to manufactured hemp. Department of Health.

Good morning, chair, co-chairs. My name is Greg Edwards with Department of Health, Office of Medical Cannabis Control and Regulation. The department stands on its written testimony in support of this measure, but I do want to just highlight that in the testimony, to be clear, the penalties for non-compliance with this requirement for age gating--sale of limiting sale to 21 and older--are administrative. So the penalty would be administrative, not criminal, apply to the retailer, not the underaged individual. Just want to make that clear. Available for any questions.

Thank you. Tai Cheng, Hemptuary Hawaii on Zoom? Not present. Tina Yamaki on Zoom?

Aloha and good morning. I'm Tina Yamaki with the Retail Merchants of Hawaii, and we respectfully oppose this bill. We want to point out that there's a distinction between CBD products which are mostly topical to help with aches and pains and things like that, and hemp is a little bit more versatile. We use it in a lot of our textile products.

There are some food, paper, biodegradable plastics, and also construction things. As you all know, retailers are very short-staffed and a lot of times we do hire 16 years old, and according to this bill now, they won't be able to sell towels and t-shirts and things like that.

And to the best of our knowledge, people don't roll it up and try to smoke, you know, their towels like doobies and things like that. There's hardly any TCH product in there, if there is any at all. It's also going to just be a lot of hardship for a lot of the retailers who probably won't either carry these products anymore or they're not going to be able to hire these youths.

We urge that you do consider the broad range of non-intoxicating hemp products and the potential negative impact it's going to have from this measure. And rather than restricting access, we should focus on education and clear labeling to ensure responsible consumer use, especially if the products do have alternating effects. Thank you.

Thank you, Tina. Also on Zoom, Mary Healy. Not present. That's all the testifiers I have on this bill. Anyone else? Yeah, please step forward, please.

Good morning, committee members. Thank you for having me. My name is Rob Bramlett. I'm the Director of Education for Rare Cannabinoid Company. We're a Manoa-based manufacturer of hemp products, and so I'm the Director of Education there since 2020, and basically what I do is I teach medical professionals who don't learn anything about this stuff in med school because up until a few years ago, it was such a forbidden thing.

There's one elective credit in med school where you learn about this stuff, so very often what I do is teach people about this stuff. So if you have any questions, please feel free to ask. The number one thing that she was pointing on that I just want to teach you guys real quick is the quick difference between hemp and marijuana. They're both cannabis and people can't tell the difference looking at them, right?

But the only way you can tell the difference is to put it under a microscope, right? And so the number one ingredient in marijuana is THC, right? If you want THC, you're looking for marijuana, right? There's 150 other cannabinoids that exist in hemp and marijuana cannabis because they're cousins, basically, and so THC is the number one ingredient.

When you look at hemp under a microscope, THC is like the 15th ingredient, right? And it's--the same is true for cannabis marijuana. When you look at that lab report, they share a lot of the same things, but it's important to understand that the reason that hemp is legal federally is that 0.3%. It's the 15th ingredient.

Now on this bill, what I would like to recommend is to understand that the industry does support age gating, right? Nobody wants this stuff in the hands of children, especially with the controversy surrounding parts of it, right, but amendments must be made to this, and so I want you guys to ask me questions if anything I say doesn't make sense. An age gating program needs to be run by the state, right? It needs to look something like what we already have in place. It can be integrated right into that program where the state has a video, where employees can watch the video and learn how to check an ID, right? That's how it's done--

I'm going to ask you to please summarize your testimony.

Basically, Section 2-C, the online sales of hemp products being regulated in here must be taken out. It's not practical. It doesn't make sense. Online verification is already done in ways that you don't understand. It's not like an adult website where you're just viewing. For a child to get a credit card--as a parent myself--the child, you have to sign for the kid to get a credit card, to have it, and then you can also sign for only children. You know, that card can be marked as a minor card. It can even be marked to only be used as swiped in person, so cannot be piped in.

So I strongly recommend that to make this bill make sense and be effective, that you remove the section about online sales because for vendors to keep IDs on file or on--you know, it's just a huge liability exposure for these small businesses.

Thank you very much for your testimony.

Thank you for your time.

Let's see. Anyone else wishing to testify on this measure? Please step forward.

Good morning, committee. Good morning, committee. My name is Tina Cloud. I am just a citizen of Hawaii, but I would like to note that there is a huge difference between industrial hemp and the products that are going into it, like hempcrete to build homes that are hurricane and termite and fire resistant, and they have no THC in the woody stalk of the hemp plant, and so if you're regulating hemp, the CBD stuff is very different than the hemp fiber and the woody--the hemp hurd that goes into construction products and, like the other person mentioned, textiles and things like that.

Thank you. Thank you so much. Any other testifiers? If not, members, questions? Department of Health? Now, maybe you can clear up my understanding of the measure. I understand this measure applies to hemp products which are clearly defined in state law to mean cannabinoid products and compounds that are meant to be consumed as opposed to what we heard about other products which may be shirts and shampoos and things. Is that correct?

It's absolutely correct. So this measurement is amending an existing law, 328G, and that law only applies to cannabinoid-containing products, both the allowance for certain forms with very clear packaging, labeling, testing, potency requirements, as well as prohibitive forms. It does not apply to industrial products.

Our conforming rules, interim rules 1137 in the applicability section of our rules, very clearly states that cannabinoid-containing products regulated under these statutes and rules do not apply to industrial products. So this would not apply to that.

Okay, thank you very much. There being no other questions. Let's move on to the next bill, which is HB 1120 relating to health nuisances. Department of Health.

Good morning again. Chair, vice chair, members of the committee, Matt Carano, Department of Health, Environmental Health Services Division. This is a very straightforward change to update the existing language to make it very clear to Department of Health needs to act when there's threats to public and environmental health, not just simply an individual's health issues. Thank you.

Available for questions. We're sending our written testimony.

Thank you. Well, that's all the testifiers I have. Members, any questions? If not, I have a question for Department of Health. Now, this- this measure, which is proposed by you, your department, suggests that the Department of Health take stronger action in response to feral bird feeding that creates a nuisance.

Can you give me an example what the department would actually do? Should you receive a complaint about, say, a neighbor who is excessively feeding birds and this creates all kinds of nuisance with their droppings and such, what would you do?

Thank you, chair. Matt Carano again, Department of Health, Environment, Health Services Division. It's not as simple as that sometimes. And I think that's why we have to introduce this idea of public health. If someone's feeding their birds, I have a bird feeder in front of my house.

It shouldn't necessarily be something that we act on, but in excessive situations where it's impacting a greater part of the community particularly, and this is really important, if when there's ever a possibility that that type of animal, whether it be a bird or other feral animal, can spread a disease, those are times when the department should be acting.

We do not want the excessive, like invasive species in particular, that can spread diseases increasing in our communities. And when there is a threat then of like a zoonotic disease that transfers from an animal to a person. Mosquitoes is a very easy example just because it's very cognizant. Avian flu as well.

We want to make sure that the department can act in that situation and not just not act, especially in the terms of prevention before there's a spread of disease.

So what would your action be?

So it starts obviously with public education. Most people will honor that once they understand why. But after that, we do have enforcement capability, but it's very much of an escalating policy unless there was something imminently critical.

Some kind of civil action.

Well, it's all civil actions. There's no criminal actions for this.

Alright. Thank you very much. Representative Olds?

Department of Health.

Department of Health. Question.

Couldn't catch you in time. Same question that chair had just asked. But if we can replace birds with something like feral cats or feral cat. Connolly.

Okay. Matt Carano, Environment Health Services Division, Department of Health. Cats, other mammals, you know, they- we have to prioritize kind of what we do with this, so when- again, I've just come back to mosquitoes, just because mosquitoes is a little bit different example. And then I can extend it to the cats part of your question.

When there's a particular type of animal that can carry and transmit a disease, you know, dengue is such an easy example, then I think the level of action by the department needs to be far more vigorous. When you start talking about other nuisances but are not necessarily dangerous or injurious to health, that's not when the department acts.

The department acts when something is dangerous or injurious to health. So I can't imagine exactly what that is. Avian flu has a connection with this, but it's not at the forefront of our thought process with cats right now. But if- if- When-

And I hope never when, but if there's ever a situation when that particular expanded animal can transmit a disease and that disease is present, then we definitely want to act because we don't want the disease to be spreading amongst people and we want to tamp it out as fast as possible.

So, like, for example, toxoplasmosis would be an environmental health issue. Would that fall under the purview of this bill in terms of your enforcement?

I think the answer is it definitely could. The situation is when, you know, we do know cats carry toxoplasmosis, and toxoplasmosis can impact environmental issues, including protected species like seals, for instance. Now, that has to be taken within the context of is there a specific outbreak? You know, is it just something that we might think is in the background?

And I think some of that does take extra work. But in the event that there were an acute issue. Right. That is harming the environment, harming the community, that's exactly the type of situations we would want to be able to act in.

Thank you.

Thank you. Any other questions? If not, let's move on to the next bill, which is HB 951 relating to prescription drugs. Kaiser Permanente.

Good morning. Chair Takayama, Vice Chair Keohokapu-Lee Loy. Excuse me. Jonathan Ching. On behalf of Kaiser Permanente. I'm sorry. Dealing with preschool germs from kiddos. I'm sorry. I'm okay.

Very timely.

Kaiser Permanente stands in strong support of this bill.

I just want to clarify, for purposes I know there's always a lot of concern when you see the word opioids.

You know, this bill I think was identified to us because as we've seen the advent of telehealth, especially post pandemic, there's been efficiencies that we feel can be made while still controlling safeguards in place, you know, from law enforcement and- and really helping to prevent against over prescribing and abuse.

So just wanted to clarify with the committee, you know, that this really is a limited narrow exemption that would allow for, you know, a pre- a prescriber within the same medical group to be able to prescribe a short term prescription of opioids for three days supply or less without that- that face to face visit.

And what we really think this will do is still ensure that safety and access while allowing for, you know, additional- additional, you know, not really having to clog the systems with, you know, with a provider for that really short term- that short term supply of an opioid.

So we're available for any questions and happy to continue to, you know, work on this bill if there's any amendments that are needed. Thank you.

Thank you very much. Let's see. We have written testimony from several individuals in support. Any other testifiers on this measure? If not members, questions? If not, I do have a question for Mr. Ching.

Your bill suggests that if a person- a person may receive an opiate prescription from someone other than the original prescribing physician, I think when it comes to opiates, we have to be careful about who does the prescribing. And you have another health care provider as having this authority. I think we should replace that with another physician.

Do you have any problem with that?

Thank you chair for that question. We're- We're not opposed to that. Just I- I think for clarification, you know, many years ago the legislature did provide prescriptive authority and this is within clinical guidelines for nurse practitioners, physician assistants, they already do have the ability to prescribe opioids and they have to get there.

And I definitely would defer to the Department of Law Enforcement with regards to their controlled substance. I don't the wrong word but there's a card that providers that have to, that are allowed to provide opioids need to register with DEA- basically the local DEA. So I- I'm not, I mean we're not opposed to it

chair, we want to continue to have this measure, continue to move forward. I think there just may be some harmonization that could be done between 453, you're right, which is definitely about the physician.

But then also, you know, we really want to empower our mid level tier providers to be able to practice to the top of their scope, you know, such as physician assistants and advanced practice registered nurses.

So, you know, if- if- if that's what the chair wants, you know, we definitely understand, want to have this con- this measure move forward, but you know, want to probably take a look closer at harmonizing it with other parts of 328/329 where there are other providers that are allowed to prescribe opioids.

Thank you.

Thank you, Chair.

In this case, we're the First Committee and it does go on for further consideration by other committees. So thank you. Let's move on to the next bill, which is HB 872, relating to epinephrine in schools. Department of Education.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and Members of the Committee. Kinau Gardner from the Department of Education, Office of Student Support Services. The Department stands on its written testimony, which provides comments on this measure. Thank you.

Thank you. Department of Health.

Good morning. Diana Felton, Department of Health, Communicable Disease and Public Health Nursing Division. The Department stands on our written testimony with comments, and happy to answer any questions.

Thank you. Anyone else wishing to testify on this measure? If not, members any questions? Seeing none. Let's move on. Next bill, HB 1112 relating to viral hepatitis. Excuse me. No, not viral hepatitis. Department of Health. I'm fine.

Good morning, chair, vice chair, members of the committee. Tim McCormack, Communicable Disease and Public Health Nursing Division. The Department of Health stands on our written testimony in strong support of this bill.

The CDC has called viral hepatitis winnable battles and we think that with the available testing technologies, hepatitis B vaccination and treatment and curative treatment for hepatitis C, a state supported viral hepatitis program could have a big impact in terms of reducing hepatitis related infections, death and preventing hepatitis infections. And I'm available for any questions. Thank you.

Thank you very much. On Zoom, I believe we have Heather Lusk, Hawaii Health and Harm Reduction Center.

Aloha chair. Nikos Leverenz here testifying on behalf of Heather Lusk and Hawaii Health and Harm Reduction Center. We stand strongly in support of this measure. H3RC has been involved in Hep Free Hawaii, which is a coalition of over 200 community stakeholders to achieve progress in combating viral hepatitis B and C.

And as- as Tim McCormick noted, you know, we- this is a winnable battle and we're grateful to the Department of Health and to this Legislature for its support in- in making Hawaii hep free by 2030. Mahalo.

Thank you. Have I missed anyone wishing to testify in this measure? If not, members, any questions? I do have a question for the Department of Health in the- this is Department of Health proposal.

As I understand. Okay.

That's right.

In the purpose clause that's written into the bill, you state that this bill is necessary to implement to eliminate viral hepatitis types A, B and C. Yet the context of the bill itself refers only to hepatitis B and C.

Right. Thank you for the question. So hepatitis A is rarely chronic, and so hepatitis B and C, where you have chronic infection.

Those are the areas that we would see certainly initially focus on the hep free Hawaii plan that the Department of Health has developed with community partnership, does include action around hepatitis A, but a lot of that really, there's really synergy in our response to hepatitis B and C and impacting hepatitis A, but that would certainly be part of the overall plan with a priority on hepatitis B and C.

Okay, so you don't mind if we clarify in the purpose clause that this bill itself is aimed at hepatitis B and C?

That would be great.

Okay. Yes.

Thank you.

Any other questions? If not- HB 1115 relating to universal immu- immunization funding? Department of Health.

Any other questions? If not- HB 1115, relating to universal immu- immunization funding. Department of Health.

Thank you very much.

Good morning, Chair, Vice Chair, and Members of the Committee. Thank you for the opportunity to testify. Sarah Kemble, Disease Outbreak Control Division, on behalf of the Department of Health. You have our written testimony, but I wanted to highlight a few things regarding this Bill.

The purpose is to decrease barriers for patients to access needed vaccines, by unburdening providers from some of the upfront costs of vaccines. This is a funding proposal, not a mandate.

11 other states have it, and it really leverages reduced cost of vaccines through purchasing through large contracts and thereby enables us to address some of the uncertainties in federal funding, to continue to make vaccines available to those who wish and need them. Thank you.

And I would add, also, that we offer an amendment to our own bill, in light of some of the federal direction of policy, and it's just some technical changes to definitions. Thank you.

Thank you very much. Let's see. Advocacy Committee, American Academy of Pediatrics?

Good morning. Dr. Maya Maxim, on behalf of the Hawaii Chapter of the American Academy of Pediatrics. Chairs, Vice Chairs, Members of the Committee, thank you for the opportunity to testify. We submitted written testimony, and we stand on that.

I would like to just highlight some of what Dr. Kemble also just mentioned, that we are in a time of risk for losing access to one of the most lifesaving public health interventions that the world has ever known. In the past 50 years, across the globe, vaccines have saved an estimated 150 plus million lives. We, pediatricians, take care of kids for whom something terrible is happening.

For me personally, I'm a Hospitalist, we have ICU Physicians in our group. We have a lot of physicians, all of us, even on the outpatient side, in our training at a minimum, and sometimes our patients, we see that terrible things happen to kids. We are at risk, potentially, of losing Vaccine for Children's—Vaccines for Children funding.

It is administered through the OMB and Mr. Vogt was just confirmed yesterday. So, I think this is a way to try to shore up access to Vaccines for Children.

About half of our state's children receive vaccines through the Vaccines for Children program, which is administered by OMB through the CDC, and the other half receive vaccines through private insurance.

Very few kids, fortunately, are uninsured in our state, and the burdens to primary care providers to provide vaccines, that they have to pay for out of pocket and may then need to discard when they reach their expiration date if they are not administered, is huge. There is a lot of administrative burden associated with that, as well.

So, this universal vaccine—state vaccine purchase program—would enable us to provide cheaper vaccines to all the kids of Hawaii and keep them healthier. Thank you, and we're available for any questions.

Thank you. On Zoom, I believe we have Tom Yamachika, Tax foundation of Hawaii.

Good morning, Chair and Members of the Committee, this is Jade McMillan, on behalf of Tom Yamachika for the Tax Foundation of Hawaii. We've submitted some comments on the measure. Our comments are primarily directed towards the establishment of the new Special Fund.

We feel the new Special Fund program, and we essentially constitute a new act on health insurers and plans, to fund the bulk purchasing of the vaccine, along with the reimbursement to the Department of Health for its cost. So, that's where we voice our concerns. We are available for questions. Thank you.

Thank you. Philip Verhoef.

Good morning, Chair and Members of the Committee. My name is Philip Verhoef. I'm a Physician here in Hawaii, testifying as a private citizen in favor of this Bill. I think one of the most important things that we learned during the COVID Pandemic was how hard it can be to access vaccines.

And it turned out that private pediatricians had a really difficult time, you know, accessing the resources in order to be able to provide vaccines to our community.

In fact, I find even now, we've had—my own family members have had a difficult time being able to access vaccines because they can't find a pediatrician that's offering some of the vaccines that that we know to save lives. And so, a bill like this removes those barriers that keep physicians from being able to provide this life saving therapy.

And so, for me as a Pediatric Infectious—Pediatric Intensive Care Physician—this is also personal, because I care for patients that suffer from vaccine preventable diseases. So, I would love to see this Bill pass in favor. Thank you.

Thank you. Next, on Zoom we have Juliet. Not present. On Zoom, Stephanie Maldonado? Not present. Faye Chieko Shimizu? Not present. Tamara McKay? Present. Please proceed.

Thank you, Chair, Vice Chair, and Committee Members. I, I stand in strong opposition to HB 1115. What is not being disclosed in earlier testimony is the funding and the outsourcing. This Bill represents massive government overreach and a violation of constitutional rights, as well as reckless misuse of taxpayer funds.

This Bill would create universal immunization funding program, using our tax dollars to purchase and distribute vaccines free of charge, forcing citizens to pay for medical procedures they may, may personally oppose. Why should taxpayers be forced to fund a program that disregards individual choice, religious beliefs, and medical freedom?

1115 grants legal immunity to the Department of Health, independent contractors, and vaccine administrators, ensuring that no one is held accountable for adverse reactions. If the government is funding and distributing vaccines, who will take responsibility for injuries? Why does this Bill—Bill shield those administering vaccines, if they are truly safe?

This Bill ignores scientific concerns surrounding MRNA injections, which studies have linked to heart inflammation, blood clotting disorders, and immune dysfunction. The Department of Health should not be given unchecked power to promote medical intervention that may—that citizens may not trust. This is unconstitutional and violates the 1st Amendment, the 14th Amendment, and the 9th Amendment.

It is deeply concerning that our elected officials, who swore an oath to uphold the Constitution, are attempting to pass a law that erodes personal freedom, rather than protect it.

Additionally, HB 1115 raises serious legal concerns under Title 18, US Code 241, which makes it a federal crime for two or more persons to conspire to oppose—oppress, intimidate, or threaten someone in the exercise of the constitutional rights.

If this government is coercing people into compliance, by removing medical freedom and shielding itself from liability, could this not be considered oppression under the federal law? Finally, we hear the mantra over and over again—"My body, my choice."

If bodily autonomy matters, it must apply to everyone, including those who oppose this program and parents making medical condition for their children. I urge you to vote "No" on HB 1115. Stop government overreach and protect the rights of the people. I yield.

Cheryl Toyofuku. Hi, Cheryl.

Hi. Good morning, Representative Takayama and Members of the Health Committee. My name is Cheryl Toyofuku and I'm a mom, I'm a grandmother, I'm a retired Registered Nurse and also a health advocate. 30 years ago, I transitioned to more natural and non-toxic health care.

This Bill will definitely be funding things that are toxic versus building up our natural immunity to all these diseases, and I do have a different perspective from the Department of Health as to how to take care of the Avian Flu, or the Swine Flu, or the Monkeypox, or whatever comes up.

So, there's a difference of perspectives and we should have our choice as to what is put into our bodies. If you do check the CDC Schedule, you will see the CDC Schedule itself that we've been—I'm a grandma. I had three injections. My daughter had a few more.

But now the children and grandchildren are having 79 doses of 16 to 17 different vaccines. This vaccine agenda has to stop because these are lots—these are just too much for our children. If you will notice the ingredients in these vaccines, it goes from mercury, to formaldehyde, to aluminum, to aborted fetal cell lines, to things that cause cancer, like polysorbate 80.

So, um, and these are in many vaccines, and you can do your research. We have many health advocates and professionals that can also verify this information.

So, please, for the sake of our ohana, our keiki, to our kupuna, please do your diligent research in what is being injected into our children and into our families. We just ask that you please do your research on the vaccine agendas, and appropriating funds to more vaccine programs is not pono. Thank you very much.

Thank you, Cheryl. Melissa Kim.

Thank you, Chair, Vice Chair, and Committee Members. Aloha from Maui. I'm Dr. Melissa Kim, community pediatrician practicing on the outer islands in strong support of HB 1115. I was hoping I could come here and shed some light on what the outer island pediatricians go through on a regular basis with vaccine purchasing. For those pediatricians and majority do see Medicaid and private, there's two separate pay plans that we have to do for each and every vaccine we offer for the kids.

As far as Maui goes, I know in our practice that we have had to put several kids on wait lists because shipping times, the orders were not received on time and we are not able to offer vaccines when they were desired by our patients and families. And we do this on our regular operating years.

Should anything interfere with that process, we would not be able to offer that health care for our keiki. So in strong support for 1115. As Alaska has done in the past, our other non-contiguous sister state, and has had great responses for that. I support it, as it will lower our health care costs, lower the difficulty in getting those vaccines, and allow us to have a steady stream of stock for those vaccines for our keiki. Mahalo.

Thank you very much. Stacy Diaz on Zoom. Not present. Noela von Wiegandt on Zoom. Please proceed.

Yes. Good morning, gentlemen and ladies. And it's Noela von Wiegandt. People run from my name. I'm in opposition of this and for a very personal reason. Everybody knows their children and make decisions for their families. Absolutely. I respect. But in my personal experience as a child, I had to take the vaccines to enter school here in Hawaii in the 60s, and at that time there were very few vaccines. But nevertheless the vaccine that I received gave me the Guillain–Barré paralysis for several months as a little child. I was 7 and 8.

I could not walk, I couldn't play. I had to stay in my parents room, and my eight brothers and sisters would rub my legs and just my parents were terrified. My kidneys nearly shut down. So that's just one example, and it's mine and I own it. But it happened to me and it's happened to many others. I didn't even remember it until recently in the COVID years when an older member said you have to be very careful. And you know, we want to take care of the people of Hawaii and the children, mostly the children. But I'm concerned that this will.

It has a companion bill of 1118, and I'm nervous about it only because of what I went through. I wouldn't want anybody to go through this. So be very careful about this particular vote. It's a good idea so that people can get to it, but children don't need 72 vaccines. They just don't.

I personally took three and they did that to me. So I know this may seem frivolous to some of you, and in summary, thank you for your time. And just be very, very thoughtful because it stunted my growth, and I was held back in school, et cetera. So there you have it. That's what I have to say. And thank you very much for your time. Aloha.

Thank you. Not frivolous at all. Kerwin Canionero. Not present. Let's see, we have... Anyone else in person or on Zoom wishing to testify? In person? Please step forward and identify yourself.

Aloha, Chair, and Vice Chair, Committee Members. My name is Gary Cordery. I'm a father, grandfather of seven. And I'm certain as we listen to this testimony there's universal agreement on the health care of our keiki is of primary importance. The question is what method should be used.

Cheryl spoke eloquently about care without the use of vaccines, the implementation of vaccines, the vaccine schedules accelerated pace. We've seen as stated from the last caller, it went from 3 to 79 currently. Yet we've seen the health of our keiki nationwide plummet. There are many peer review studies and many PhD and many doctors have actually took a distinct stance stating that the vaccine schedule is not healthy for our keiki.

I agree with the last caller said that I believe that this universal... First of all, when I hear universal purchasing agreement, that brings fear. That you as legislators would actually authorize a universal purchasing agreement to stockpile vaccines for the state is a companion bill to 11118.

I strongly oppose and speak for the Aloha Freedom Coalition's 20,000 members. We strongly oppose this bill. We believe that healthcare should sit with the parents. There's not a mother in this room that does not have the innate, uncanny ability to understand what's going on with their kids.

I can tell you many times my wife has said no, that's not what's going on with my... She birthed my kids. That we as a society and this legislative branch would actually supersede that and give this healthcare policy and make it a protocol. Stockpiling vaccines, empowering the state to implement vaccine protocols for this state will have dire consequences on the health of our people. It will also initiate an exodus from this state. It will also initiate an exodus from DOE.

Thank you. I'm going to ask you to please summarize.

I appreciate that, Mr. Takayama. So I am strongly opposed to this bill. I hope that my heart that you hear this is about what's best for the kids. Thank you very much.

Thank you. Anyone else? Please step forward.

I'll just spend on my personal. I'm not representing my Department at this moment. 23 years ago, I worked for the Department of Health as their legislative coordinator. At the time, families that had children with autism were very traumatized and really blamed the vaccines. And I was one of the main recipients of that information.

I as a parent was really affected. And so what I did for my, instilled so much fear in me, this rhetoric. So my daughter is almost fully vaccinated, but I fought with the pediatrician to do single doses because I fell to this rhetoric, but I didn't do one, the HPV, because I fell to this rhetoric.

It was scary. This noise, this sound that you all are making, I understand it. As a parent, we want to protect our children. 23 years later from that time to this, children are not getting vaccinated, and I regret not giving her the HPV. She might have a risk of cervical cancers and other cancers because of this noise. Thank you.

Thank you. Please step forward.

Good morning. Tina Cloud again, a concerned Hawaii citizen. I am in strong support of this bill. Vaccine preventable diseases, many of them almost completely eradicated because of vaccines. Vaccines have saved millions of lives across the globe. Currently, funding, federal funding for vaccines and public health is likely to go away.

And so it's extremely important that the state step up to fund these so that children can get vaccines to protect them from things like measles and polio and other vaccine preventable diseases that have almost gone away. And we currently are seeing many of them make a rise back. So please, I'm in strong support of this bill. Thank you.

Thank you. Anyone else? Please step forward. If there's anyone else, please line up.

Hi there. Thank you. My name is Dr. Casandra Simonson. I'm a pediatrician, came over from Maui, been there for over 10 years, in strong support of this bill. I stand on my written testimony that I submitted, but I just wanted to just bring it to your attention, the mandate part, that this doesn't mandate anyone having to get vaccines. But also just to let you know, we're facing several whooping cough outbreaks in Maui right now.

In the last 10 years, the rate of my patients that are vaccinated dropped from like 55% to 35% just in the last two years. And that's for children under two to be fully immunized. And so it's just been a really, really dramatic shift. I'm really scared, and it feels like, you know, we're very isolated.

We don't have an ICU for children on Maui. You have to rely on transport, just like the other outer islands. And, you know, it's just getting really scary over there that we're going to have a more serious outbreak, especially with measles. I don't think it would be good for our tourism industry to have a measles outbreak on our island, especially with no higher level care for children. So I just wanted to emphasize how risky it's getting and how scared your pediatricians are. Thank you.

Thank you.

Thank you for allowing me to speak. I, all of you on the Committee. I am a taxpaying citizen of this state, have lived in Hawaii since 84. I'm a retired nurse.

Could you identify you, yourself?

My name is Loretta Dubin. What I have seen has impacted me directly, my family members. First of all, I want you to know I'm opposing this 1115. The funding is inappropriate for taxpayers to have to pay that. I believe in my body, my choice. I also believe that I was given a God given immune system as all of our children have been born with and we ourselves all have. I beg of you to please consider that no one, no doctor, healthcare person can usurp what God has done. I'm just going to tell you that straight up. They don't have all the answers. None of us do. But we know who does. So I just ask you to please, please don't do this. If you want another generation of health, please vote no to 1115. Thank you.

Thank you very much. Any... Oh, please.

Hey, everybody. My name is Renee Cavello. I reside on the west side of Oahu. And I was inspired to come up based on other people's opposing testimony. Today I'm going to oppose this bill because we should have the freedoms. It shouldn't even be a religious exemption requirement, that kind of thing. I'm sorry, I'm pretty emotional about it.

I know that people are scared of potential risk to HPV in the future, which is something that they can cure by eating particular food items and reduce their chances of getting the cancer. I personally had Guillain-Barré syndrome like the previous caller, as a child. Doctors brushed it off as growing pains. So I did have adverse reactions.

I have a history of genetic markers. I have three nephews that are autistic, and they have immune issues. I have a sister that also has psychological issues, and I oppose this because we don't really know what it's doing. We really want to see the information that JFK Jr. is going to bring up.

Then when that comes up, we can rediscuss this because we want transparency and we want real testing. Vaccinated kids versus non-vaccinated kids. And let us make that decision. I'll be happy to get vaccinated once I can trust the systems that are in place to do this. And we shouldn't be forced to pay for this.

And it's unfortunate people that don't have vaccines, that want them, don't have them. I agree. They want it, they should have it. They made an informed decision for themselves, and we're asking for ourselves to have the informed choice to not put these things in our kids' bodies. Thank you.

Thank you very much. Last call for testifiers.

Hi. I'd like to testify.

Let's go to... We have one testifier in person, and then we'll go to you on Zoom.

Cynthia Bartlett, mother. You know, this vaccine discussion is getting very all or nothing, and that's not the case with vaccines. You know, if a serious disease came along, there's no question that people would get vaccines. It's just the question of this extra funding. I believe it's from the Governor.

And then along with the funding comes the fact that they're liability free. I don't know if you know this, but years ago, my partner's a doctor. Years ago, pediatricians would take the minutes to say to check if a child had a flu in the recent week, and if they did, they would not give them a vaccine. And now they don't ask.

I'm sorry, on Zoom, please mute yourself.

And now, for example, they don't ask that question anymore. They just give the shot. And their reactions, it could be very serious reactions. We have a friend at Kaiser that went into a coma for that. So just to make the doctors all liability free is is wrong and that should be deleted. So please don't think of vaccines as all or nothing. I mean it's ridiculous. We need to have common sense. We don't need 72 vaccines or vaccine companies are trying to come up with like 200.

And there's a lot of reimbursements. Just like the during COVID, a lot of money exchanged hands for offices that really had high percentages of vaccinations. And that's still going on today. And so you have to think of the conflict of interest. There's a conflict of interest. Thank you.

Thank you. On Zoom, please proceed and identify yourself.

Hello?

I'm sorry. Go ahead.

Hi. I'm so sorry. I got some kind of disconnection issue. I'm testifying to oppose 1115. You know, I agree with some of the other testifiers.

Would you tell us your name?

You know, we can't be funding these vaccines to the state right now, especially when we have one in 34 having autism in the United States right now. We're not--that rate went up from one in 10,000. I agree with the previous testifier. Now that we have Robert Kennedy Jr. who is going to be the Secretary of Health and Human Services, you know, there are 77% of Americans right now currently who have lost their trust in the CDC guidelines and what vaccines are going to be pushed through for the state to fund because--I'm not entirely against vaccines.

I do believe that there are vaccines that have been proven effective, but I have a difference of opinion in what vaccines maybe the state would be funding, so I just stand in opposition to this bill and I thank you for hearing my testimony, and you know, I think that we as a culture need to be concerned about what's happening to the United States. Thank you.

Thank you. For the record, would you please tell us your name? Mary? Is that Mary?

Oh, I'm so sorry. I'm so sorry. My name is Mary Healy. Thank you for hearing my testimony.

Thank you. Anyone else on Zoom? Anyone else on Zoom, please proceed.

Hello, can you hear me?

Yes, we can. Please tell us, is this Arica? Arica?

It's Arica Cornejo.

Please proceed.

Hello. I just moved here from Connecticut. I'm from originally Florida. My husband got military orders here three to four weeks ago. My car is still in Long Beach. I have two kids, 8 and 11. My 11-year-old is going to be starting middle school, well, actually seventh grade, and I saw that HPV is a mandatory vaccine here.

I was very surprised why an HP--a sexually transmitted disease vaccine is mandatory for children. It makes me emotional to think about it. I had a horrible reaction to a few vaccines that I was forced to get. So moving to Hawaii, I was extremely excited, and now I'm hearing that the religious exemption may be removed was a complete shock, only being here four weeks. I'm opposed to this--

Excuse me, but you're actually--I'm sorry--pardon but, I think you're actually addressing--I think you're actually addressing a different bill on the agenda, which is coming up. You mean to address HB 1118 and we're right now discussing a different bill. So if you'd like to--

I'm sorry. I just moved here and my mind is all over the place as you can see.

I appreciate that, but, thank you. You can stay on and come back.

Let me, let me go back to that. I'm against--I feel like it's parents choices to vaccinate their children. My kids are fully up to date by the way, and I was all for vaccines until the recent Covid vaccine I got very sick from and I was sick for months, so I am happy to be here on this earth so I can speak today. Thank you.

Thank you, and so are we. On Zoom, we have one more person, I believe. Please proceed. Oh, is that it? Okay. Any other testifiers? If not, let's go to questions, members. Representative Amato.

Thank you, chair. I have a question for one of our doctors from the neighbor islands of Maui. Please come on up. I think it was--I'm interested in speaking to the one with--about that--spoke about the extended shipping delays. I'm sorry, I forgot your name. Please forgive me.

Hello, committee. It's Dr. Melissa Kim.

Thank you, Dr. Kim. So you mentioned these extended shipping delays to the neighbor islands when it comes to vaccines. I have four kids, so I know about the dosing schedule, and you're supposed to get boosters within certain windows and timeframes.

That's correct.

Have there been any instances where these delays in shipping has disrupted the dosing schedule leading to parents to have to begin the cycle over again for their children?

Not necessarily cycle over again that I'm aware of, but yes, delays. In their routine scheduling, so they'll come in for a well child check every--depending on how old they are--two months to six to one year, and in some instances, we were not able to offer the vaccine because it has not arrived or we were out of stock. It's a delicate balance between ordering enough vaccines and not having too much so that a large amount expires. That's wasted money. And so there's that balance, especially with private insurances and so that's always a dance that every clinic has to play.

I understand. Thank you so much.

Thank you. Any other--any other questions, members? Seeing none, let's move on. Just note for the record that on this bill, we have--we received testimony from 106 persons in support and 115 in opposition. Next bill up, we have HB 866, directing Department of Health to stockpile mifepristone. First up, we have Department of Health.

Good morning, chair, vice chair, members of the committee. Lorrin Kim, Department of Health, Planning and Policy Officer. The department submitted comments supporting the intent with some recommended amendments to provide us the greatest amount of flexibility as the situation evolves. Thank you for the opportunity to testify, and I'm available for questions.

Thank you. On Zoom, Ann Freed? Not present. James Wallace? In opposition. Anyone else wishing to testify on this bill? Please step forward.

Maya Maxym, pediatrician. On this occasion, I'm speaking just as an individual, not representing anyone else. I would like to just tell you a quick story. About ten or 12 years ago, I took care of a 12-year-old who had given birth to a baby that was the result of a rape by her own father.

This baby was the one that was admitted, but the 12-year-old was the age of my patients. We are facing a lot of threats to health and well-being nowadays and one of them is that medication abortion could go away at a federal level.

I think it is extremely important that anyone have the opportunity to access mifepristone and that it is our job as folks who care about the health and well-being of everyone in our state that we should make that available as long as possible in appropriate circumstances. Thank you.

Thank you. Anyone else wishing to testify? If not, members, questions? Representative Amato.

Testifier, chair.

Oh, I'm sorry. Please step forward.

My apologies. I support--submitted testimony on behalf of the Hawaii Women Lawyers. It was late. Anyway, Mihoko Ito, on behalf of Hawaii Women Lawyers. Thank you, chair, vice chair, members of the committee for the opportunity to testify. We do support the intent and spirit of this law.

We believe that the unfortunate reality under the current administration is that we expect to see significant reductions across all reproductive health services. We have some concerns about how this law might be implemented if passed, especially given possibility that federal law, the Comstock Act, could be revived, and we believe further discussion is needed to sort of triage and figure out what the best use of funding is to protect reproductive healthcare. So we just wanted to make those comments. We'd be happy to participate in any discussions going forward. Thank you.

Thank you. Last call, testifiers. Please.

I'd like to testify.

Oh. Let's see, we have one person here in person. We have one person in person and then we'll go to you on Zoom. Please.

I'm Dr. Melissa Kim again, pediatrician on Maui. This is a personal testimony, not from my profession. I've experienced a couple miscarriages in my life and one of them required this medication. The alternative to that would be a surgical D&C, which is where they go in with general anesthesia and cleaning you out, which is associated with much more risk than, let's say, the medication.

And so if we are facing a shortage of it or for it to be repealed, you're putting just women on, you know, birthing age women at risk because miscarriages are not something that we can technically help ourselves, so thank you.

Thank you. On Zoom, Mary Healy? Please proceed.

Hi. I'd just like to say that this medication is not always effective at ending pregnancies, and for that reason, I oppose having a stockpile of it in the state. Thank you.

Thank you. Last call, testifiers. If not, Representative Amato.

Thank you, chair. I have a question for Department of Health, please. Thank you for being here. Aloha, Lorrin. So, first question: do you think it's important that we ensure supply on each island within each county?

The department's priority is to assure that all Hawaii residents, regardless of the county or island they live on, have access should they choose to take this medication, yes.

Thank you. So I'm interested. How would the Department of Health arrange supply on every neighbor island?

So that is under active planning and discussion. There are a lot of variables. Ms. Ito mentioned the Comstock Act. There are certain FDA approvals that are needed for risk management plans. We are currently assessing what facilities could aid in the distribution of mifepristone. So this is a priority. It is being actively worked on. HB 866 is a, is a supplement to some of the activities that are--that we're looking at.

Thank you. Would HHSC be able to play an important role in ensuring supply on the Big Island?

So we are in discussion with HHSC. There are many logistical implications, and I understand. I've been told that HHSC is looking into the impacts to their systems. For example, do their internal pharmacies--what--are they prepared for FDA approval for risk management strategies? So we are currently--we have initiated discussions with HHSC. We are hopeful that they will be able to accommodate this essential need, but the devil's in the details and we're looking into those details.

The devil is always in the details. So one last question. How can we ensure supply for the neighbor islands like, such as Maui, Molokai, Lanai, and Kauai?

Again, we are actively looking at different ways of distributing mifepristone for individuals who elect to take it. Again, some of the issues that are complicating this are the Comstock Act and, again, various federal hoops that we have to jump through.

So we are fortunate that partners and stakeholders like HHSC and the Hawaii Primary Care Association are at the table. This is going to be a state and private partnership. I wish I could give you a slam dunk answer, but it is a priority to make sure that counties other than the City and County of Honolulu have access to this. So neighbor islands are at the forefront. I mean, Oahu as, as you know, as a representative from a neighbor island, we, we have everything.

So it's relatively easy here, and we're making sure--we're working hard to make sure that our neighbor island residents have equity in access to this. I just don't have the details at this time because there's so many things in flux.

Thank you. I appreciate that. Would Malama I Ke Ola be able to partner and ensure that there is supply on Maui?

So Malama I Ke Ola is a private entity. It is a federally qualified health center and a member of the Hawai'i Primary Care Association. Most of their members are--most of their patients would be Medicaid or underinsured, uninsured. We have a strong relationship with them and we will work with anybody who is willing to step up and help us figure out how to distribute mifepristone to those who elect to take it.

Thank you, and another unrelated--well, related, but--have you worked with DHS's director to see how they may also support this effort? Is there any involvement through Medicaid or anything like that to assist in this process?

So our colleagues at DHS are generally aware of our activities. In the past, they have been strong partners when there have been federal restrictions, such as the Hyde Amendment. For example, in medical aid in dying, they were very willing and supportive to engage with the Department of Health to implement medical aid in dying, where we only use state funds rather than federal funds through FMAP.

So we anticipate that they will be at the table and willing to figure out how--Governor Green, who has made this a priority--how we can implement this and make this available statewide.

Thank you. Thank you, chair.

Thank you very much. Vice Chair.

Thank you. Follow up, and I really want to appreciate my colleague, Ms. Amato for really leaning in on the needs of the neighbor island, and I just want to put it out there for you and/or any of your partners. The power of a Legislator is the power to convene, and so if you need help to get people to the table to have this conversation so we can start to iron out the details, please lean on my office. I'm sure Mr. Amato would be more than happy to do the same for Maui County and our neighbor islands on Kauai. So, putting it out there.

Thank you for that. We are actively working with Rep. Amato's office and we would be very, very pleased to engage you in your district and in your county, and I will follow up with your office and we can talk story on how we can proceed.

Great. Thank you. Thank you, chair.

Thank you very much.

There being no other questions, let's move on to the final bill on the agenda, which is House Bill 1118, relating to non-medical exemptions to immunization requirements. Now I know there is intense interest, as evidenced by the number of testimonies we have received on this bill.

Going to remind everyone, I'm going to ask that you please abide by our two minute time limit. Because if we run out of time, and we do have a time deadline, because we do have a session following this hearing. If we run out of time, we'll simply have to cut off testimony and go to decision making. So with that, let me begin by receiving testimony from the Attorney General.

Good morning, Chair and honorable Committee Members. My name is Kaena Keao and I'm here representing the Department of the Attorney General. The Attorney General provides the following recommendation to replace the wording on page 11, lines 13 to 15 to clarify that an individual does not have to be a part of an established church and that any religious exemptions would just have to be in conflict with the person's bona fide religious tenets. Thank you for the opportunity to comment, and I'm available for any questions.

Thank you. Department of Education.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and Committee Members. Kinau Gardner, Assistant Superintendent for the Office of Student Support Services, testifying on behalf of the Department of Education. The Department stands on its written testimony providing comments on this measure. Thank you for the opportunity to testify.

Thank you. Department of Health. Welcome, Director.

Aloha, Chair, Vice Chair, and Committee Members. I'm Dr. Kenny Fink, the Director of Health. The Department of Health supports this measure, but I do not do so lightly. With the responsibility to protect and promote the health of the public, I feel compelled to proactively raise awareness of the increasing risk of vaccine preventable disease in Hawaii.

Vaccination rates have been declining nationally and in Hawaii. This has been associated with an increase in outbreaks. For example, measles was announced to be officially eliminated in the US in 2000. However, in 2023 there were four outbreaks on the mainland and 59 cases in total.

And in 2024, this increased to 16 outbreaks on the mainland involving 284 cases in total. Of the 2024 cases, 42% occurred in children under five years old and just over half of them were hospitalized. I don't have mortality data. While we have not yet had a measles outbreak in Hawaii, we have had increases in pertussis cases.

In 2023, there were three reported cases of pertussis and last year there were 80. We have had a travel related case of measles in Hawaii. We were lucky. Luck is not a good public health strategy. Herd immunity is when enough of the population is immunized to protect the rest of the population that's not.

When the percent of the population that's immunized is below herd immunity, the non-immunized population is no longer protected and becomes at risk of infection. The percentage of the population that needs to be immunized to have herd immunity depends on the contagiousness of the infectious pathogen.

Measles is a highly contagious pathogen and requires about a 95% population immunization rate to achieve herd immunity. The overall non-medical vaccine exemption rate has been trending upward, and the upward trend is expected to continue if not accelerate. Last year it was 5.3%. This means that non-medical exemptions alone preclude having herd immunity for measles.

This means that students with a non-medical exemption who were protected by the other students who were vaccinated are no longer protected. This means that students with a medical exemption who are unable to get vaccinated for medical reasons are no longer protected. This means that we are at risk, and likely increasingly so, of a measles outbreak. This risk is among the threats to the health of the public that causes me the greatest concern. Vaccinated students help protect the students themselves who are vaccinated.

They also protect the student who cannot get vaccinated for medical reasons, the teacher who may not have had a robust immune response to vaccination, the family kupuna who may have waning immunity. Vaccinated students also help protect the community. I understand that this measure is controversial, and there will be compelling arguments for and against.

While we may disagree how, I would like to believe that we share the goal of keeping our keiki healthy and safe. Too often it seems a crisis happens and we react. We might ask what could we have done to prevent it. Now is the time to prevent a measles outbreak.

We have the opportunity to be proactive to protect our keiki and community from vaccine preventable diseases. This is an important policy decision. I hope the measure advances to continue discussion. Mahalo for hearing this measure and for the opportunity to testify.

Thank you, Director. Hawaii State Council on Developmental Disabilities.

Daintry Bartoldus, Executive Director for the Hawaii State Council on Developmental Disabilities. We are in support. As the Director has stated, herd immunity is extremely important to our population. Many of our individuals are medically unable to get evasive vaccination and being integrated and enjoying their community can put them at risk. So we stand in strong support. Thank you for this opportunity to testify.

Jamie Detwiler, Hawaiian Islands Republican Women. I'm going to ask you, to those standing in front of the door, can you please step to the side? You're blocking people. Thank you. And as well, could you please step to the side or... Thank you. Please proceed.

Good morning. Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and Members of the Committee. Jamie Detwiler, Hawaiian Islands Republican Women. We stand in strong opposition to HB 1118. This bill is in direct violation of our US Constitution as well as our Hawaii State Constitution. Under the US Constitution, our First Amendment protection of religious liberty cannot be subjugated by a state law.

As a retired healthcare professional and a consumer of healthcare myself, we are entitled to inform consent. Every time we go to the doctor's office, whether it be for a vaccination or for an in office treatment or for in the hospital for surgery, we have informed consent. This is no different in getting vaccines.

Hawaii State Constitution Article 1, Section 4, no law, I repeat, no law shall be enacted respecting an establishment of religion. This bill proposes to eliminate the section where it gives the parent and guardian the ability to submit an exemption form. It's crossed out in the bill, meaning the bill proposes to delete it.

It also goes on to add the Department of Health, pursuant to Chapter 91, may adopt rules it Deems necessary for public health. This gives the Department of Health authority over parents' rights. It also adds no objection from parent or guardian shall be recognized when in opinion of the Director of Health there's a danger of an epidemic.

This gives all power to the Director of Health. These are unelected bureaucrats that are trying to convince us that they know better than parents and guardians. Please preserve our constitutional right of freedom of religious liberty and our God given inalienable rights. May I respectfully remind you that our actions today will impact future generations to come. Please vote no in HB 1118. Thank you for this opportunity to testify.

American Academy of Pediatrics Hawaii Chapter.

Good morning again. Maya Maxym on behalf of the Hawaii Chapter of the American Academy of Pediatrics, representing more than 200 pediatricians across Hawaii. Chair, Vice Chair, Members of the Committee, thank you for the opportunity to testify. There's so much I would like to say in two minutes. We stand by our written testimony, first of all.

Second of all, I would like to just take this opportunity to say we are open to questions about vaccine safety. Dozens of excellent studies have been performed showing that vaccines are safe, that they are effective, that they are cost effective, and that there is no causality between vaccination and autism. I want to make that clear from the beginning. I also recognize, as others have said, that everybody who is a parent wants the best for their children. I recently turned 50, and my uncle was in the first polio vaccine trials in the 50s.

My mother remembers not being allowed to swim during the summer because of the risk of polio when she was a little girl. When I was a little girl, I lived downstairs in a three family house, three apartment house, from someone who had survived polio as a child and never left her house because she couldn't get in or out.

And I think, respectfully, that perhaps part of the reason that there is so much fear about vaccines is because we have forgotten what vaccines really do for us. I have been in practice for well over a decade, going on two decades now. I have never seen a case of polio.

The reason I have never seen a case of polio is because of vaccines and because of the incredible public health miracle that they are. I have, however, seen measles, chickenpox. I have seen pertussis and I have seen meningitis. I have seen the only child of a single parent die from the flu.

All of those are vaccine preventable diseases. I also take care of children who are fragile. Children who need a tracheostomy to breathe, who have a tube for feeding. Yep, I will. So medically fragile children, children with cancer and other kids, cannot receive vaccines or cannot mount a robust immune response to them. So we need to protect those folks with herd immunity. They all have freedom to participate in society, and I believe in freedom. And we as pediatricians believe that vaccinating as many children as it's safe to do is part of that freedom. Thank you.

Thank you. Kim Cordery. Not present. Erin Austin.

Aloha, Chairs and Members of the Committee. I am here today to testify in opposition. The state wants to eliminate religious exemptions to vaccination to protect the immune compromise. That is not a valid argument based in science. I am the daughter of a pediatrician and the mother of three children.

One of my children has a compromised immune system, and we do not vaccinate due to our sincerely held religious beliefs. I have not vaccinated my two healthy children to shield my other one and nor would I ever. It took my unvaccinated family two years to catch COVID. That vaccine did not stop transmission.

Just like so many others on the childhood schedule. In our household, we are actually more concerned of someone who could unknowingly be carrying an illness because they took a vaccine that only offered a reduction in symptoms making them an asymptomatic carrier. Remember them?

Or worse yet, someone who's been vaccinated with a live virus vaccine that can shed and spread the man made vaccine strain. I urge you to vote no on this bill because not only is it a violation of of our fundamental human rights, our God given rights, and our constitutional rights, I would never expect another parent to light their child on fire to save mine.

Thank you. On Zoom, Jessica Montero. Please proceed.

Hi. Thank you for having me today. I'm here today as a concerned mother. My name is Jessica Montero and I am here to express my strong opposition to HB 1118. This bill is unnecessary and if passed would infringe upon the religious rights of the people of Hawaii. The First Amendment of the Constitution explicitly protects these rights.

I have always homeschooled my children based on our religious beliefs. However, when my eldest son reached high school age, he expressed a desire to attend school to experience a traditional high school environment. My son is exceptionally bright and aspires to attend the Massachusetts Institute of Technology in the future.

In support of his goals, we enrolled him at HIT Hawaii Technology Academy, a public charter school. He is now a sophomore and thriving in his academic pursuits. Through HTA's Career Based Learning Program, he is currently in his second year of an internship at a video game development company.

If HB 1118 is enacted, he would be left with no choice either to withdraw from school and he would no longer be able to continue his education here. That would be a devastating setback for his future. CJ is not a threat to his classmates. He is rarely ever sick.

He has never contracted a disease for which the CDC recommends vaccination, nor has he even ever had the flu. Our family prioritizes a healthy lifestyle, which has contributed to the overall our overall well being. In my experience, unvaccinated children tend to be healthier and way less frequently ill.

Even if this bill would allow my son to be grandfathered in, his little sisters would never be allowed to go to school. Countless other families and keiki would also be forced to either move out of state or homeschool based on their bona fide religious beliefs. Religious exemption has never caused a threat or outbreak in disease. The Department of Health just told us there is was no cases of measles here. There is no...

Thank you. I'm going to ask you to please wrap it up. Please summarize. We need to move on.

Okay. Therefore, there is no, there's no reason for this bill to even go through. This is our fundamental religious freedom and our right. Thank you for your time and consideration.

Thank you. Adeline McGonigle on Zoom. Please proceed. Okay, let's move on. Krystle Ilar on Zoom. Not present. Sophie Sidhu on Zoom. Please proceed.

Thank you. Good morning, everyone. My name is Sophie Sidhu. I am a proud resident of our Aloha State. I'm an educator. I care deeply about inclusivity. I'm a caring community member and a mother, and I'm here to strongly oppose this bill. This bill is a violation of our fundamental and constitutional right of religious freedom.

Faith practices and the right to education must be mutually respected by all, regardless of anyone's personal faith belief. If enacted, this bill would cause significant harm to families across the islands and tear apart the fabric of our Aloha State. I implore you to uphold our constitutional integrity and protect the right to religious freedom.

To not put families in the impossible situation of disregarding their faith practices or so that they could send their kids to school and having to choose between the right to education or the right to practice their faith. So I'm here to strongly oppose and please ask that you vote no on this bill.

Thank you. Victoria Ng. Not present. I'm gonna try. Arica Cornejo. Please proceed.

Hello. It's me again. I, as a parent, I oppose 11B118. My kids are fully up to date with their vaccines. I've moved to many different states, and this is the first state that has a mandatory re-vaccine policy for seventh graders to attend school. This is not aligned with my religious beliefs. I feel parents need to have rights for their children. I was really excited to move to Hawaii because of one of the things was having an exemption religiously. Please vote no on this bill. Thank you.

Thank you. Dylan Sheldon on Zoom. Not present. Carla Antonio. Not present. Sheila Medeiros.

Good morning. Good morning, Chair, panel. I'm Sheila Medeiros. I am a retired army officer, served this country for 34 years. Deployed to Afghanistan three times and Iraq once. So I understand what freedom is. And today for me, this is freedom of consent. I strongly oppose HB 118 for several reasons. As a mother of a grown child with autism, I have personally witnessed the profound impact that vaccines have on my child's development. My child's life has been irreversibly altered due to childhood vaccinations.

Additionally, my 18 month old granddaughter has only received two vaccinations that were required because her parents have decided against the rest of the vaccinations due to concerns about their efficacy. Interestingly, my daughter in law has four co-workers who had babies around the same time frame. All of their children received the required vaccinations for 18 month olds.

There's a stark contrast in the health of my granddaughter compared to the other children. She rarely gets sick and is very healthy, unlike the other three children who are constantly sick and suffering from immune disorders at 18 months. I am grateful that my son and daughter in law are strong advocates for their baby even in the face of their physician's recommendation. If you're not aware, the 79 vaccinations, I guess I thought it was 72, on the children's schedule, have not been thoroughly tested.

Therefore, why should this legislative body mandate untested vaccinations for children, especially when many parents have legitimate scientific and religious objections? Furthermore, it has been discovered that some vaccines contain fetal tissue derived from aborted fetuses. I urge this panel. I urge this panel to thoroughly research the information I presented here and consider sources beyond your state funded resources. I also challenge Governor Green to debate doctors and scientists who oppose the mandated vaccinations for children if he truly committed to the implementing this legislation.

I'm going to ask you to please finish.

Thank you. I oppose this is... Allow people to make choices for their children.

Thank you. Chelsea Leitner on Zoom. Not present. Noela von Wiegandt on Zoom. Please proceed.

Oh, hi. It's me again. Noela von Wiegandt in opposition of HB 1118. You heard my personal testimony previous on 1115. My own experience with the Guillain–Barré. I would like to also add that I too was able to receive a religious exemption and a doctor's exemption under my personal health history during the COVID years. During that time, several members of my family, they made the choice to take it, and sadly my older brother died because of the COVID vaccine. But anyway, I digress.

The thing that's very important to me is that people know how to take care of themselves because I was little and I had that bad, bad, bad, terrible thing happen to me. From 15 years on, and I'm close to 70 now, I've always been holistic in my own personal health care as well as my daughter. So I'm very thankful. The thing that scares me a lot about this is that the state would like to force people to do what they think is good for their children, which is not right.

The other thing that's frightening is the Religious Freedom Restoration Act, which allows the courts to exempt people from laws that substantially burden their religious beliefs. You know, I come from a large family, and during the time when I was little, we prayed and prayed and prayed because, I mean, I could have died. It's real simple.

And sadly, in the last several years, I've watched many of my friends, co-workers, colleagues, family members die because they took these vaccines. I'm not saying that they're all bad. I'm just saying there's overwhelming evidence that they're not perfect. Please vote no on this and just know the people of Hawaii truly love their children. And we respect you. And please, please, please do not push this one through because it's going to cause a lot of problems. A lot of people will leave the State of Hawaii. Thank you very, very much. God bless you all.

Shelby Hosana on Zoom.

Aloha. Good morning. Thank you for your time today. I am a mother of three on Maui as well as the founder of a large organization, Unjected, which helps to educate those about the harm harms of vaccinations. And I am here today in strong opposition against this bill. As of course many of the speakers have said, it is against our God given rights and it is also against our constitutional rights. I was also vaccine injured myself by the HPV vaccine as a teenager, and I know firsthand how detrimental these vaccines can be.

As we do know there has not been one proper placebo control group study on any vaccine on the market. And for any of the physicians there today, I would really implore you to educate yourself on how vaccinations have never been stopped, or excuse me, vaccinations have never stopped communicable diseases. And with all that being said, lastly, we have served all of the representatives today in the room with a formal cease and desist letter and our legal counsel is waiting and standing by.

If you intend on passing this bill, we will be pursuing every single one of you with full legal action, as this is against all of our constitutional and state rights. So you will have that in your emails. You are welcome to check. And lastly, I really implore you to do the right thing. God is watching and the particle board table at which you sit upon will not stop the wrath of God and the wrath of the people. Thank you for your time.

Thank you. Philip Verhoef.

Thank you. I'm Philip Verhoef. I'm an adult and pediatric ICU physician here in the islands testifying in strong support of this measure as an individual. In addition to being an ICU physician, I'm also a PhD trained immunology researcher, and I'm more than happy to speak to the safety and efficacy of immunizations. But I want to be clear.

My interest here is really in the health and safety of our population. I certainly don't have any financial conflicts of interest. I just know that it breaks my heart to care for critically ill patients, keiki to kupuna, knowing that their illnesses or their deaths could have been prevented.

These non-religious exemptions create barriers to population level immunity, as Dr. Fink noted, and this leads to outbreaks of preventable diseases and this strains our healthcare system. I cared for COVID patients during the Delta outbreak when we were strained nearly to the breaking point when an immunization was actually available, even while we were running out of oxygen in the state, scrambling to figure out how we were going to care for so many critically ill patients.

And so the state should strive to limit these kinds of barriers to immunizations, these barriers that are not supported by medical or scientific research, in order to assure that as many people as possible receive immunizations. Doing so, your support reflects a commitment to protecting our population, and especially our keiki, from unnecessary suffering. Thank you for the opportunity.

Thank you. Reina Loughlin on Zoom. Please proceed.

Good morning.

Good morning. Please proceed.

All right. Chair Takayama and Committee Members. I'm destin—opposed, Bill HB 118—1118, excuse me. My husband and I are people of faith. We have five children. We believe that we were created by the Creator, the most high God.

And from the beginnings of time, he gave us freedom of choice and still does today, including making decisions over our own body and those of our children. I understand that people are concerned about protecting the public, but it is our God-given right to have autonomy over our own bodies and to protect our own children.

It is not anyone else's right to choose what is injected into the bodies of our children. No Governor, no government, no person or group can play God and make decisions over our body and health. This is unconstitutional.

And Josh Green and those supporting this Bill would be playing God, but I'm sure will not be taking any responsibility for the health risks or harm done by these vaccinations. Nor will they admit the link between vaccinations and health issues. There's undoubtedly arguments on both sides about what is misinformation or research-based data, such as a pediatrician who studied 10 years of patient history showing big health differences between vaccinated children and those who didn't take any on the CDC childhood immunization schedule.

And he confirmed that the more vaccines you had, the worse you were. Sickness, infections, ADHD, neurodevelopmental issues, eczema, allergies, and anemia, just to name a few.

There are millions who can give personal reports, who suffer from vax injuries or experience loss of loved ones, without anyone taking accountability or being able to reverse what's been done. So, taking away religious exemptions is discrimination against religion. It's reckless and frankly, a crime against humanity.

Children should not be forced to take these vaccinations or disregarding the family's religious beliefs. They should not be denied public education for not complying, nor be cornered into complying with this overreach. It's this kind of overreach that my family...

Thank you. Can you please conclude?

...Avoided five years ago when we started homeschooling.

Thank you.

There are families who are going to make difficult decisions and who have been, to quit their job to homeschool their children, suffering financial loss among other hardships, and there's families that will continue to rely on public education.

Can you please conclude?

So, for that, for those reasons, I believe that the the Bill is unconstitutional, and religious exemptions should not be repealed.

Thank you. Also on Zoom, we have Julie. Not present. Can I remind testifiers that, you know, we are asking you to limit yourselves to two minutes. We're going to run out of time, and those who are not able to testify will simply have to not be able to testify. So, we do have a number of testifiers still left.

Tyler Villamelle, on Zoom? Not present. Clarice Philomel? Not present. James Nakamura, in person? No. Shannon Mako. Please proceed.

Can you see me?

Yes. Please proceed.

Hi. Aloha, Members. I'm Shannon Mako and thank you for taking the time to hear the voice of those that you represent. I'm here today as a mother of three, some of which have received medical exemptions. My children will be described as exactly who Bill HB 1118 would attempt to protect.

However, I am here firmly standing in opposition of this Bill. My kids are not in danger of kids with religious exemptions. Removing religious exemptions is a direct violation of our U.S. Constitutional right to practice religions without fear of persecution and removing this exemption in Hawaii would be just another overstep and overreach in a long and ugly history of government here.

A small number of children that this Bill claims to protect would be massively outnumbered by the number of children it would alienate.

Food and home insecure children, that rely on our public schools for meals and safe adults, would be exiled and put in danger, simply because their religious beliefs are in direct conflict with some or all of the 79, including COVID, vaccines that have been added to the CDC's Childhood Schedule.

If HB 1118 has a financial incentive for passing here, I urge you to consider that in many communities, you will actually see parents that are able to pull their kids out in droves, in order to protect their freedoms. This is shown in other states that have done this and removed religious freedoms, such as California.

It would be catastrophic for the funding in many of our schools that rely on attendance numbers to get the funding that they need. This is not going to get you the results that you're hoping for. It's not going to cause people to change their religious beliefs and get more shots.

It will backfire and they will be out of school and in danger. I speak on behalf of my own three children and on behalf of the thousands of other children that rely on religious freedom here in Hawaii.

You cannot claim to protect a tiny percentage of children by potentially injuring and violating an even larger number of them.

Thank you. I'm going to ask you to, please.

So, please—thank you—please oppose Bill HB 1118. It's what your constituents want and are urging you to do, not what Governor Green is telling you to do.

Thank you. On Zoom, we have Anastasia Thomas? Not present. Alfred Medeiros, in person? No. Jasmine Jenkins, on Zoom? Please proceed.

Aloha Committee and Chair. My name is Jasmine Jenkins. I'm a mother and on behalf of my family and myself, I strongly oppose this Bill. It's extremely unsettling to hear that a family's ability to make decisions about their child's health, in relation to their religious beliefs and values, would be taken away.

Additionally, their constitutional rights being challenged, being that the first clause of the First Amendment states, "Congress shall make no law respecting an establishment of religion or prohibiting the free access thereof, forbidding Congress from both promoting one religion over others and also restricting an individual's religious practices."

This violates our religious rights under the Free Exercise Clause, as well. As in similar case in Mississippi, Bosarge v. Edney, in 2023, where they upheld religious exemptions, they had to determine whether the law was in fact to repeal a generally applicable or neutral law.

A law is not generally a pit poll if it invites the government to consider the particular reasons for a person's conduct, by providing a mechanism for individual exemptions. A law also feels being general applicable if it prohibits religious conduct while permitting secular conduct that undermines the government's asserted interest, in a similar way.

A policy is not neutral if it's specifically directed at religious practice, meaning that it discriminates on its face or religious exercise is otherwise its object. This Bill sells that neutrality or general applicability suffice as proceeding.

The relevant question, however, it seems, is not whether the compelling interest enforcing this Bill is a general interest to the public, but whether the general interest is denying religious freedom to a people.

Our Constitution of our state states, in Section 1, all political power of this state is inherent in the people and the responsibility of the exercise thereof rest with the people. All government is founded on this authority. No citizen in Section 8 shall be disenfranchised or deprived of their rights.

Thank you for your testimony. Please.

It's deeply troubling to hear that our state government, founded on these authorities and constitutional rights, force communities of religion into choosing their own religious beliefs, child's health, their education, while simultaneously upholding constitutional rights for some and marginalizing their...

Thank you very much for your testimony.

A family's right to...

I'm going to ask you to please end.

Yeah. In summary, I respectfully submit that our public health needs should be weighed in balance with families right to their religion. Please vote "No."

Thank you. Jacqueline Bozeman, in person? Stephanie Maldonado, on Zoom? Dr. Cassandra Simonson?

Thank you, Chair, Vice Chair, and Committee for having me. My name is Dr. Cassandra Simonson. I'm a Pediatrician in Maui where I've worked with the underserved and Native Hawaiian community keiki for over 10 years. I'm speaking today on my own behalf, and not representing anyone else, in strong support of HB 1118. I love babies.

I love helping parents find those little moments of joy in between the worried ones. And as a parent of three keiki myself, I know parents never want their babies to feel pain or suffer. Your worst fear is that they could die. I want to take this opportunity to do something that I should have already done.

I want to apologize to families who are hesitant to immunize. I have often avoided talking much about immunizations with you, out of fear. I didn't want to push you away. Recently, I heard from a mother who had lost her daughter to meningitis, and she said outright, my pediatrician never told me this could happen.

If I would have known, I would have given my daughter the immunization. It dawned on me that in my attempt to be friendly and approachable, that I was doing you and your child a disservice by not clearly telling you what it is like to watch a child die from meningitis.

Every time I watch a family sign a refusal form, my memory flashes back to a hospital room and moans and wails of a mother and father screaming for their daughter. The father chokes out words, "I'm so sorry I missed your birthday party." I see her pupils fixed and staring from the pressure of pus in her brain.

My hand is holding my stethoscope to her chest, hearing her heartbeats come further and further apart until they stop. I look up and nod in acknowledgment to the family and nurse that she's gone. Time of death. May you never hear those words. May I never speak them again. Every time you sign an immunization refusal, I relive this.

And yet, I haven't told you that story. I owe you an apology for the brief conversations about immunizations and not for better helping process your feelings, your fears, and the rumors that you've heard. I am here today because your keiki are worth it. Every keiki deserves protection. Thank you.

Thank you. Lauren Pear on Zoom? Not present. Jesse King on Zoom? Not present. Fei Shimizu on Zoom? Anela Kealakai? Not present. Liano Keola Mora Duquette? Not present. Tamara McKay? Please proceed.

Thank, thank you, Committee. I stand in opposition of HB 118. It is unconstitutional, unethical, and an alarming overreach of government power. This Bill strips parents of their fundamental right to make medical decisions for their children and forces vaccinations, without regard to personal beliefs, medical risk, or parental consent.

It is deeply concerning that our elected officials, who swore an oath to uphold the Constitution, are attempting to pass laws that directly violate it. 8—1118—tramples on our 1st Amendment rights to religious freedom, our 14th Amendment right to due process, and our 9th Amendment right to make personal medical decisions.

Stripping away religious exemption is not just wrong, but it's unconstitutional. The First Amendment protects religious freedom and forcing individuals to violate their sincerely held beliefs is an unlawful government overreach. If the government can force vaccinations today, what will they try and strip away tomorrow? This is not China.

In America, we do not allow the government to dictate forced medical procedures on citizens against their will. We are a free nation, not a communist state. Our laws protect individuals from government tyranny and 1118 directly violates these protections. Even more troubling—removes accountabilities for vaccine related-injuries.

If a child suffers harm from a mandated vaccine, who takes responsibility? The government, the Department of Health, or the pharmaceutical companies? This Bill offers no protections for families left to deal with the consequences. Additionally, it also raises serious legal concerns under Title 18, U.S. Code 241, which makes it a federal crime for two or more persons to conspire to oppress, intimidate, or threaten, in the exercise of their constitution rights.

Furthermore, 1118 ignores the role of natural immunity. The Amish community, which largely avoids vaccinations, has lower rates of chronic illness and relies on natural exposure to disease to build lifelong immunity.

Their life expectancy is equal to or greater than the U.S. General population.

I ask you to please conclude.

I urge every citizen through to thoroughly read through the bills, not just what is publicly promoted, but what is verbally hidden in the language. Who truly benefits? Big pharmaceutical companies, government interest and corporate, at least, but it's not the people.

Thank you for your testimony.

It's constitutional and a power grab, and I urge you to vote "No."

Next, on Zoom, we have Darren Miller. Not present. Lauren Borowski, on Zoom. Not present.

Lynn Bloom.

Mercedes Ross. Not present. Molly Gella. Oh, I'm sorry.

Good morning. My name is Molly Gella and I'm a Registered Nurse of 28 years. I'm deeply saddened to have to be here today, because this Bill has no place in the halls of our Capitol.

Our Founding Fathers put in place safeguards around such tyranny to protect us from the need to fight for our inalienable rights, endowed by our Creator. It begins with our First Amendment. This Bill, to remove our religious exemption from public schools, is in direct violation of our religious freedoms protected by our Constitution.

Parents, not elected officials, get to decide, based on their deep held beliefs, whether or not they want to vaccinate their children. Hawaii, with our dictatorial Governor Green at the helm, continues to have no regard for the citizens of Hawaii and our rights to bodily sovereignty.

In 2021, I, and many of my fellow coworkers, fought a similar fight with our employer against the COVID shot. For months, we lived with the uncertainty of whether or not we would lose our job. We were at the behest of our employer.

By the grace of God, my religious exemption was approved, while a fellow Nurse and good friend, who sat right next to me in church, was denied her religious exemption. She was among many denied their religious exemption.

Now, you representatives sitting before me, in support of this Bill, please tell me how any man or woman has the right to make such a decision about our own—about one's deep held beliefs. You who vote in favor of this Bill are making an even bolder statement, excuse me, than my employer.

You are saying we do not care about your deep held beliefs and you do not have the right to exercise your God-given religious freedom. What you fail to realize is these parents of public-school students, fighting to keep their religious exemptions—they are cut from the same cloth that thousands who lost their jobs are cut from.

So, I implore each and every one of you considering voting in favor of this Bill, please rethink your decision, because what you are telling this small minority of individuals, who are exercising their God-given rights, is you have no voice. You have no rights. What you believe doesn't matter.