House Standing Committee on Health

Good morning, everyone. Thank you for being here. This is Friday, March 149:00am in room 329, Committee on Health, and like to welcome Vice Chair Lee Loy as well as Representative Takeniuchi to this hearing. Just some ground rules. Excuse me. We have a suggested time limit of two minutes for each speaker.

That's to enable us to wrap up and enable us to have decision making before session, which we are actually required to do. Also, for those on Zoom, please keep yourselves muted and your video off while waiting to testify. If for any reason you're disconnected, you may attempt to rejoin the meeting.

Actually, and also if we're disrupted by a false alarm, fire alarm, as has happened frequently in the last few days, we may have to recess and reconvene after that.

But anyway, with that, I'd like to move on to our first Measure, which is SB 1441, relating to the transition of the Oahu Regional Health Care System from Hawaii Healthcare Systems Corporation into the Department of Health. Or not. First up, we have State Department of Health, Marian Tsuji.

Good morning, Chair, Vice Chair, Members of the Committee, Department of Health strongly supports this measure, which would repeal the action that was taken in Act 212 that would transfer Oahu region over to the Department of Health.

We feel that we are able to accomplish the goal of utilizing the campus and other items that were intended with that and just offer some clarifying amendments to the Bill regarding the types of reports that you would ask for and we'll be available for questions. Thank you.

Thank you very much. Sean Sonata, Oahu Region.

Good morning, Chair, Vice Chair, Committee Members, Sean Sonata, on behalf of the HHSC Oahu region, withstanding our lengthy written testimony and support and note that we are aware of the Department of Health's requested amendments and we have no objections to those amendments if they are adopted. And I'll be happy to answer any questions.

Thank you very much. Edward Chu, Hawaii hhsc. Good morning, Chair. Vice Chair. Stand on its written testimonies in support. Yes, thank you. Let's see, that's all the testifiers I have. We do have a statement from, uh, expressing support. Anyone else wishing to testify on SB 1441 here or on Zoom, if not Members. Questions, Representative. Taken.

I think, for Department of Health. First, I know a lot of the testimony does indicate that the MOU is currently being worked on. Could you give a little more detail about what that looks like? And. But it's still you. You still would like it to be necessary in the Bill case.

Maybe just a General update on that work.

We've been working on an MOU so that long term care patients that are over at the hospital would be able to be transferred over to Leahi. And so it just kind of specifies the types of support that we would provide Leahy with and kind of, you know, what would happen if it doesn't work out.

And is there an estimate about how many patients we're looking to transfer?

Right now we're looking at about 10 to 15.

And that's available space that's already been identified.

These are folks who are in our housing unit that are not ambulatory.

I mean on the, on the other side, I guess, or maybe Sean then.

Sorry, Sha can't answer.

And there's, there's, there's space for all the patients that we're looking at doing the MOU for.

No, there's no space currently. But what we're doing with the agreement is trying to facilitate a situation where as soon as a space opens up, as long as the potential patient is I guess, qualified that they could transfer over pretty easily.

You know, we would have an overarching agreement that these are the terms and conditions that would govern the admission. If we have an agreement, then it's easier to start the transfer. But it all depends on our availability.

But there's no bed space available.

I thought. When spaces become available then we'll start the transition of a patient. But we had one space recently available and we're currently in the process of admitting one. Right, right now. But it's a slow process.

It's not like we can if they have a need for 10 to 15 that all of a sudden will sweepingly bring 10 to 15 people in is on a case by case basis.

Because as I noted in prior hearings, US and all the other long term care facilities have a staffing shortage, particularly with cnas as we have the staff to accommodate further admissions, then even though we have a space available, a bed available, we might not have the staff for that bed.

But when that opportunity arises then of course we would be able to admit. But we cannot admit 10 to 15 people right now. We're admitting one because we had one space. And if another one opens up in the future, then the same thing would apply.

Based on the staffing. It's based on the staffing, not the bed space.

Okay.

Okay, thank you.

Thank you.

Any other questions, members? If not, I appreciate the testimony from DoH and Wahoo Region and thank you for working on this memorandum of agreement. And it enables us to move forward, I think. Let's move on to the next bill, SB 1443 relating to DoH payment rates for state hospital patients. And Department of Health.

Aloha chair, vice chair, and committee members. I'm Mark Linscott, hospital administrator at HSH. As my former colleagues and others talked about our geriatric kupuna patients that are at the state hospital, there are about 10 to 15, but there's a whole unit of 40 patients. So this bill allows us to exempt some of the procurement.

So in the event that we can't get them to Leahi or to other areas, we could set a rate above Medicaid so that our patients get treatment in a foster home or community level. And so that would be the first one.

The bill also has us doing rate setting for medical services that we don't provide at the state hospital, that our sister organizations help our patients and to set that at a Medicaid rate, which is basically community standard.

And as many of you folks know, we have encumbered folks under the Department of Health Director, which means they're not eligible for Medicaid. But most of our patients majority would qualify for Medicaid if they were not in the hospital.

So we want to set the parity, if you will, of the rates that we're being charged and being able to pay and happy to entertain questions.

Okay, thank you. You may stay up there because you're the only testifier. Members, any questions? I do have a question. What is the Medicaid rate?

So the Medicaid rate, I mean, so there's. It's going to be less than 1,000 beds per day. $1,000 per day. And that's kind of what our run rate is. And so it's between, it's less than what's in the jail and it's between the $1000 rate.

And have you done preliminary investigation as to whether there are health providers that would offer these beds at that rate?

Well, that's what we set the rate with them on that basis.

And so when our patients go for emergency care, that would be. Rather than having them set the rack rate, which is whatever the customary charges that they would charge a patient, the rate would be at the Medicaid rate, which is what most folks in our institution would qualify qualify for if they were out in the community.

I guess what I'm trying to get at is are there community beds available at that?

I'm going to say yes. There's, there's at least one provider that's very interested in providing services for, for our folks.

Okay, thank you, Representative Marten.

To that. So I'm assuming this is a really challenging population to care for in someone's home. Do they have special training or skills?

We would be able to provide those special trainings and the skills to work with psych patients. But when we're talking about long term care patients, we're talking about folks that are not ambulatory and whereas they may have been very active violent, that's not the population we're talking about.

Thank you. No other questions. Thank you. Let's move on to SB 1322, mental health. And first up, we have the Department of Law Enforcement, Director Lambert.

Good morning. Chair, Vice Chair, and Members of the Committee. The Department—I am Mike Lambert, the Director of the Department of Law Enforcement. We stand in strong support of this Bill. By allowing crisis intervention-trained officers to make that decision in the field can reduce the time it takes for them to access care via the MHEW System.

What it also does is allows officers the flexibility and discretion to utilize hospital services over jail.

Because typically what happens is under a high stress situation, the officer, if there's a crime afoot and they have to make the decision between ending the activity or calling the MHEW, sometimes they'll just arrest because it's just quicker and it places everyone at less risk. By giving that ability for a CIT trained officer in the field to say, you know what, I think it's best that we take you to the doctor, it allows that discretion.

Right now, the MHE system is great and there's nothing against it, but there are times where just calling is not practical. So, we do support this Bill. I'll be available for questions.

Thank you. Still not used to seeing you out of uniform. HHSC, Edward Chu.

Good morning. Malia Espinda, HHSC. You have our testimony in support with amendments. I'm going to add to it. I've been part of this MH1 law since 2009 when our now Governor was the Chair of the House Health Committee. So, we've been—I've been—definitely part of this.

What was at the time, the doctor champion at the time was Neil Gowen Smith and it was at the behest of a major grant called the Mental Health Transformation Grant and the MH 6 group. This intercept model-based law, MH 123 and such is actually a jail. As you're right, I have a hard time too.

Director Lambert has indicated is rooted in a jail diversion. At the time, it was all positive intent. Since then, what we have seen is the proliferation of the shift from jail to our ERs, and in the time span that we've seen this law unfold, what we've seen is what I call air traffic control.

There was somebody before and now we have the MHEW process. And I was pretty skeptical. You can ask Dr. Koyanagi. I was skeptical of the air traffic control being through Queens and that MHEW. But in truth, for HHSC, that is critical. Our ERs cannot—we already see it at Queens.

It is happening on the neighbor islands where our ERs are even smaller. So, it is, with all due respect to Director, it is critical that we have that air traffic control. It is a great partnership. I have checked with all of my regions, and it is working. They're great partners with us.

So, while I understand somebody like Director Lambert would be able to recognize when somebody is maybe 9, 10, in crisis, we have to think of the layman law enforcement. And they need to work through the MHEW. We need that. So, that's our first request.

One of our amendments. Another one is we echo whatever with work with queens on the MH 3 because that too has an impact to our ERs. And then on the 48 to 72, we are working through with Queens on some, some issues of what we're going to agree on. Not that area. So, thank you.

Thank you and for everyone's benefit, MHEW is mental health emergency worker. Attorney General.

Hi. Good morning, Chair, Vice Chair, Committee Members. Ian Sudo with the Department of the Attorney General, providing testimony in support of this Bill. This Bill represents a comprehensive reexamination of Hawaii's mental health code. The goal is to clarify existing laws, as well as to enhance them.

The Bill reflects the input and concerns of various stakeholders involved in the mental health system, as this is a Bill that we've been working on since the end of the last session.

And we believe that it's going to provide Hawaii with a useful framework that providers can utilize as they continue to develop mechanisms in the community to help care for people facing mental health challenges.

So, specifically, in our testimony, we're recommending that some revisions be made to the provision regarding emergency transport of individuals under an order for ACT that was made by the Senate Judiciary Committee in the preceding hearing. We believe that these revisions will better achieve the intent behind those amendments.

We also recommend that the liability protections for emergency workers and ACT workers be restored. And other than that, I'm available for any questions that the Committee may have. This is a pretty extensive Bill. It's many pages and you change one thing, and it affects like five other things. So, you know, the complications are already present.

I'm available to help explain our, our propo, our—this Bill—to the Committee. Thank you.

Appreciate that. I, I know a lot of work went into it.

Thank you.

Department of Health. Okay, thank you. In support. Hawaii Disability Rights Center.

Yes, thank you. On Zoom. Yes. Good morning, Chair. I'm Lou Ortishek. I'm the Director of the Disability Rights Center. Most of the Bill is actually, I think, fine. It's a clarification of the existing law. It tightens it up and so forth.

We have two issues. Actually, this morning, I did not see the Attorney General's testimony, but we absolutely oppose the reinsertion of the liability exemption. That was in the original Bill. The Senate Judiciary Committee wisely took that out. The basic law is just negligence. If you commit negligence, negligent act, you're liable.

There are a few exceptions in the law here and there where the standard might be gross negligence. This is certainly not one of them. I was kind of surprised to see that in the Attorney General's testimony and we would definitely oppose that.

The other issue that we have with this Bill is the order to treat procedure at the Hawaii State Hospital. So, it's not quite like the discussion we had about the three panel, the one panel on fitness to proceed the other day. But basically, under the current law, the order to treat is an odd process.

If somebody is going to be involuntarily medicated, typically you have to go to court and get an order from a judge. State law allows that if somebody is committed to the state hospital, they can be involuntarily medicated, in a non-emergency scenario, after a hearing in front of a three panel, there's a psychiatrist, a psychologist, three healthcare providers.

This would bring it down to one. Basically, there's not a lot of due process that these people get. The intent when the law was put in was to have the three panel at least provide some buffer.

So, other than the fact that it's inconvenient for the people at the state hospital to get three people together, we don't see any basis for going from three to one. So, thank you.

Thank you. Next, we have Queens Hospital. Sandra Lee G. Brendan.

Thank you.

Thank you. Thank you. Chair Takayama, Vice Chair Lee Loy, Members of the Committee. My name is Sandra Lee G. Brandon. I'm the Vice President of Behavioral Health and Medicine at the Queen's Medical Center. I'm also a Psychiatric Mental Health Nurse Practitioner.

I am the original mental health emergency worker at Queen's and the one who brought the program to Queen's Medical Center in the first place. Queen's appreciates the intent of this measure to help and support individuals suffering from mental illness or substance abuse.

Our testimony attempts to address how we do ways that respects the patient and doesn't adversely impact acute care hospitals like Queens. It's our belief, based on our experience, that SB 1322, as drafted, could potentially have a negative impact on the delivery of care at our facilities.

The current MH 1 process, which we agree with Malia, works well. Prior to the process—prior to the process, one of the reasons why Queens bid for the process was we found plenty of people coming in with a police escort or police transport that didn't need to be in a hospital setting.

And that was the impetus and why we bid for the contract and developed the MH 1 program the way it is now. So, our proposed amendment simply seeks to add—oh, so our proposed amendment simply seeks to add to the MH 3 process to mimic the MH1 process where we include a mental health emergency worker in the decision making.

We believe that this is reasonable and tested compromise that provides reasonable guardrails for all parties. And so, the proposed amendment on page eight would add the mental health emergency worker into the evaluation process for the healthcare providers.

And we're also fine with deleting the entire section of the Bill and work with the introducer and the interim to find a suitable compromise. So, thank you for considering our request and I'm available for questions, should you have them.

Thank you very much. Let's see, that's all the testifiers I have on 1322.. Did I miss anyone? Oh, yes. Please step forward.

Aloha Chair Takayama, Vice Chair Keohokapu-Lee Loy, and committee members. My name is Carrie Ann Shirota. I'm the Policy Director for the ACLU of Hawaii. Apologize our testimony was a little late, but it didn't get into the record.

We strongly oppose this measure because it lacks due process safeguards and will likely result in the significant deprivation of liberty and opens the door to a legal challenge and liability. First and foremost, courts have been clear that liberty interests of the individual, even if facing mental health issues, must be carefully protected.

This has been affirmed by the U.S. Supreme Court in Vitek v. Jones, by the Ninth Circuit in Suzuki vs. Yuen.

En Rado by the Hawaii Supreme Court in quoting civil commitment or even in this case detention even if for a shortened period of the mentally ill for any purposes constitutes a significant deprivation of liberty that requires due process protections.

And I'd like to further quote from the Hawaii Supreme Court to be considered dangerous to self under the Hawaii statutory scheme, it is not enough that the individual is unable to satisfy the need for nourishment, essential medical care, shelter, or self protection without supervision and assistance of others.

There must also be clear and convincing evidence that the individual's inability to satisfy their need for nourishment, essential medical care, shelter, or self protection without supervision and assistance of others will probably result in death, substantial bodily injury, or serious physical debilitation or disease unless adequate treatment is afforded to the individual.

End of quote from En Rado. We support and acknowledge the fact that the intention behind this is to provide further support but not at the expense of infringing upon people's constitutional rights? Research is very clear that voluntary treatment is more effective than involuntary treatment. There's numerous studies that we've cited here.

We'd also like to point out that the assisted community treatment is fundamentally flawed. We have previously removed the right to legal counsel that's guaranteed in family court which is a closed proceeding from assisted community treatment. This is something we need to keep bringing to the record because this is ripe for litigation.

If you are about to potentially pass an order even in under an act order that includes involuntary medication, that person is entitled to have legal counsel. All the more so if that person is experiencing mental health challenges, illness, or co occurring with substance abuse treatment.

Second, we'd like to point out in the termination of the order that the proposed bill states that the court can only revoke the order if there is no objection to terminate an act order.

We suggest that you change that that if any person or any party petitioner the person who's the subject of the order, the clinician, if there is an agreement that there is a hearing and the family court should make findings on the record with legal counsel present for the indigent person.

Number three, relating to emergency transport, and I'm learning some new terminology today from our cohort, we want to emphasize that we should invest in mobile crisis response systems like in Oregon, the CAHOOTS program, also known as mobile crisis on every island, not just on Oahu.

That model has been proven to assist people who are experiencing mental health crisis and these people are trained specifically for that.

No disrespect to our officers, but having CIT training X number of hours, it could be 40 or maybe a little bit more, is not the equivalent of someone who has trained for years to assist individuals with mental health crisis. We'd like to see investments in that.

But if you look at the provisions 3334, emergency transportation initiated by a law enforcement officer that's being referred to as MH1 has a second layer of review. That officer, upon observing firsthand behaviors potentially dangerous to self or others, they are required to call a mental health emergency worker who is specifically trained. That's a second layer of review. But in 334.

Can I ask you to please summarize if you can.

In 3334C, it also has a second layer of review. It's not only somebody would be the licensed physician, a nurse, a psychologist, attorney, even a clergy could call in. But this, you have the court reviewing this emergency transport.

But under the third 3334D, it only requires a health care provider. There's no second layer. This is imbalance. So we also support either removing this entirely or adding amendment to make it consistent with MH1. And we want to highlight the involuntary medical treatment panel is absolutely necessary to have three and not one.

Imagine if one person could make the decision to deprive you of liberty.

Thank you very much. Anyone else wishing to testify on.

Thank you, Chair.

SB 1322? Seeing none. Members, questions? Representative Takenouchi.

Thank you, Chair. I'm not sure, maybe for law. So I'm also kind of concerned with this question in 334D on page 8 about bypassing the mental health emergency worker. Is this, did this? This is an admin bill. So I was just wondering are you guys, is this did these amendments come from your department?

Is there like an issue that we're trying to look at or?

Sorry, which section specifically?

Sorry, page eight. So this is the thing that Queens and HHSC and ACO just mentioned about having the healthcare providers not really opening up the kinds of healthcare providers that can do the transaction.

Yeah. So 344D basically would be similar to the MH2 where someone else is telling us that they meet the standard. And essentially law enforcement for 334D would just transport on that, on that request.

Are you guys opposed to making the same process with calling for a mental health emergency worker?

For 334D, no. If. I mean, if it would actually. Because that would be. That wouldn't be law enforcement that are, that it's making initial contact. So. Yeah, I mean, obviously if there's a second screener, it would reduce liability for transport, because in that, in this scenario, in 334D, we wouldn't be the one making the determination.

So I guess having that extra layer would probably make it easier on law enforcement in regards to what would, what may come during transport. So I'm not against that. Thank you.

Thank you. And just I might mention that, you know, it's my inclination to accept the suggested amendments from Queens Hospital which would insert the mental health emergency worker. So I think that addresses many of the concerns we've heard expressed by testifiers. Can I ask the Attorney General to step forward? Relating to that, 334D.

I know that among your amendments is slight changes to 334D. So assuming we adopt the changes proposed by Queens, I would like you to be able to sit with Queens to discuss how their proposed changes would affect your proposed changes. And we have time because the bill still has to go to Judiciary Committee afterwards, so.

Certainly, certainly. And just one comment on 334D. So this is one of those examples of us trying to enhance or clarify the procedures in existing law. 334D is essentially a reflection of what's located currently under 334-59A3, which is why it's called like MH3123. Yeah.

But there was no real way to effectuate how this was supposed to be accomplished and so the changes made here are kind of minimal in that regard.

And I think the belief behind this provision, why it was originally there, is that these categories of healthcare providers, physicians, APRNs, physician assistants and so forth, are professionals with the type of expertise that would be able to make determinations regarding issues of eminent danger in mental health.

We're just inserting or reinserting the MHEW. Okay. Thank you. Oh, Representative Marten.

I have a question for Queens, please. I. Two parts, actually. One is, is there any capacity issues with the mental health emergency workers? And second, are they successfully diverting people to our crisis center, our new crisis center? Is that working?

Yes. So is there any capacity to the mental health emergency workers, as in the number of people? Yeah. No, we don't have a capacity issue because Queens is a big system. So we're able to support that program. And as far as are we able to divert? Yes.

I can tell you statistically, over 90% of MH1s used to go to hospitals, but that's down to like 60 or 70%. So we're able to divert about 20% to either community areas or now even to the BHCC, where we've even changed our algorithm to certain districts being able to go directly to the BHCC.

Thank you. Thank you very much. Thank you for all testifiers. Let's move on to the next bill, SB 1422. Vital Statistics Special Fund, Department of Health.

Good morning, Chair, Vice Chair, Members of the Committee. Lauren Kim, Planning and Policy Officer for the Department of Health. The Department will stand on its testimony, everyone in strong support of this measure.

This is a measure that effectuates the recommendations of the Auditor to repeal the Birth Defect Special Fund and redirect funds to the Vital Statistics Improvement Special Fund, which is necessary to improve customer experience and to make sure that we preserve records dating back to the Kingdom of Hawaii. And I'm available for questions. Thank you for your support.

You might stay up there since you're the only testifier on this Members. Any questions? I do have a, I'm sorry. Go ahead. Representative Amato.

Thank you, Chair. So, thank you for being here. Does the Department of Health think that the funding in the budget is sufficient to cover the, The Hawaii Birth Defects Program?

So we do so. On one hand, this measure repeals the Birth Defects Special Fund. But in the Executive budget request, we did put it put in a line item to replenish a base budget appropriation to fund to replace the missing funds.

So I see in the budget there is 340,000, but it's for two and a half permanent FTEs. I'm concerned, you know, looking for the state teratology birth defect data. I have not seen any reports published since 2011.

Correct.

Yet this is required by. What is it, HRS 321.421. So what's Department of Health doing to bring. To not only collect that data, but make sure it's published timely as it should be.

So there actually is a Internal working group. It's part of the Maternal Child Health Collaborative to address that issue. And it's not just birth defects, but it's fetal death review, Keiki death review, maternal mortality review. Their findings are not quite ready to be made public, so we're actively discussing it.

But we recognize that this is a deficiency in our system. And again, fetal mortality, maternal mortality are sentinel events that we really need to keep track of.

And it's regrettable that we haven't kept up with our mandated reporting schedule, but we do have a group actively working on it, and they will produce recommendations to the Legislature in short order.

Okay, thank you. I appreciate that. Just want to make sure Department of Health is following the law. Thank you, Chair.

Definitely. Thank you. And I did want to follow up. Representative Amato, under the bill, how much do you expect to raise from the redirection of the vital records fee?

About $625,000 a year that's currently going to the General Fund would be redirected to the vital statistics improvement Special Fund.

$625,000 per year total from both the marriage license fee that you would capture and the vital records. Yeah, vital records. Correct. So there is an amount of money existing now in the birth defect special Fund. How much is in it?

I'm sorry, I'll have to get back to you. I don't have the current balance at the tip of my tongue.

So we've been collecting the $10 from the marriage fee. Marriage license fee to go into the birth defects Fund. Correct. Except you cannot spend the birth defect special Fund.

Well, money, is that my understanding, from the Auditor's report, Monies from marriage from issuing marriage licenses. The Department does not receive any of the $60 for a marriage license, despite the fact that the Department does all the work, all the FTE, printing the certificates, providing the resources. So this would help finance our own operations.

So we get a cut, $10 from the birth defects assessment.

It goes to a variety. So the General Fund is the largest beneficiary. I think they get almost $40. And then there are disbursements to other special funds for.

No, I meant specifically the birth defects assessment, which is $10. Where does that money go now? You're still charging.

Correct?

Where does the money go now?

So there are three special funds into which a percentage of the marriage license fee is deposited. One is the birth of a Special Fund. The. The two others are domestic violence related. One in the judiciary, one at the Department of Human Services.

But the Auditor said you shaft. You have to. We have to repeal the birth defect Special Fund. Correct. Because there's no relationship between marriage and correct defects. So you have the money from the fund and it's not being spent on birth defects. Is that my understanding?

You have to, since you have to repeal it, you can't spend money from it, can you?

Correct. And that's why we have a line item in the budget to replace so that we can continue birth defects activities funded through General Funds rather than through the Special Fund that we're proposing to be revealed.

All right. Thank you. Thank you. Pursue it later. Thank you. Move on to the next bill which is SB 1433, harm reduction. And first up we have Department of Health.

Good morning. Chair, Vice Chair, Members of the Committee, I'm Tim McCormack with the Communicable Disease and Public Health Nursing Division of the Department of Health. The Department of Health is in strong support of this bill. Syringe exchange has been a critical public health program in Hawaii for decades.

And this measure would allow a number of improvements to the current statute to really align the program with current best practices. The most important of these would be to permit the program to transition to need based distribution.

Hawaii is one of only two states in the country that currently limits, still limits syringe exchange to a strict one for one exchange.

When we're successful in getting people who inject drugs to take steps to reduce their risk by attending a syringe exchange program visit, and then we're not able to give the number of syringes that they need to ensure that they are able to inject with safe equipment, sterile equipment each time, we're really missing an opportunity.

A number of the other provisions in the bill are really related to supporting that provision. And I appreciate the Committee hearing this bill and I'm available for any questions you may have.

Okay, thank you very much.

On zoom, we have Hawaii Health and Harm Reduction Center.

Aloha Chair, Vice Chair Members, Nikos Leverens, on behalf of Hawaii Health and Harm Reduction center, we, you know, Hawaii took a great leap back three and a half decades ago when it implemented its statewide syringe exchange program.

And over three and a half decades, our syringe exchange program has kept the incidence of HIV rates low amongst injection drug users and their intimate partners. We strongly support this bill which, which moves us toward a needs based program in alignment with best practices.

And you know, syringe exchange also provides people access with acute care like that provided by our multiple medical unit, as well as HIV testing and screening and link and linkages to services, including treatment. So thank you to the Department of Health for their support over the years and to you for advancing this Bill. Mahalo.

Thank you very much. Let's see. We have also on zoom. Brett Colbus.

Good morning Chair Committee Members. My name is Brett Colbus, a 20 secured Navy veteran and live in Ewa Beach. I strongly oppose SB 1434. While the intent to improve immunization access is commendable. Or are we. No, we're on 33. Sorry. Yes, we're on the. I oppose 1433.

Yes.

This bill will fundamentally alter Hawaii sterile needle and syringe exchange program. This bill poses significant risk to public safety and community health while potentially enabling drug use. Shifting to a needs based distribution system from the current one to one exchange model could lead to dramatic increases in needle litter litter as seen in cities like San Francisco.

The exchange threatens the safety of our beaches, parks and public spaces putting children at risk of accidental needle sticks. Band program to include non injecting drug users sends a dangerous message to that normalizes drug use. Rather than addressing the root cause of addiction. This approach risks encouraging enabling substance abuse.

The proposed liability protection for the program participants staff law enforcement may have unintended consequences. While intended to remove barriers to participation, protection could be exploited potentially hinder law enforcement efforts to address drug related crimes. Furthermore, this bill creates an open ended program without clear limits or solutions to addiction.

A risk straining our state's resources and budget potentially at the expense of other vital services and treatment programs. Instead of expanding this program, we should focus on evidence based addiction treatment and prevention strategy that address the underlying issues of substance abuse.

I urge you to vote no on SB 1433 and prioritize solutions that truly help those struggling with addiction while maintaining the safety and well being of the Hawaii residents. Mahalo.

Thank you very much. Let's see, that's all the testifiers I have on this measure. But I might note that we have a number of written testimonies both in support and more in opposition. So have I missed anyone wishing to testify on SB 1433? On Zoom or present?

May I please testify?

Yes, please. Tell us who you are.

I'm Mary Healy and I'd also like to testify in opposition to this bill. I'm concerned about the normalization that this can cause and facilitating further drug abuse in the state. And like the previous testifier stated, I think that their money could be spent to facilitate drug prevention.

And for those reasons I oppose this bill and I hope that we maintain the previous program. Thank you.

Thank you. Anyone else wishing to testify? If not the Members questions.

Representative Chun, question for Department of Health. Thanks so much for being here. So I understand the intent of the program, but I'm just wondering how does this look in practice and how is the needs based program determined for like someone who comes in? How do you determine what the need is?

So it would be the number of. They would indicate the number of syringes that they need. Right now they bring in the number, they bring in syringes and they can only get the number that they have.

Often what happens is people lose syringes, they're stolen or they're confiscated and they go to the syringe exchange program without any needles. And at this point the program has to turn them away. And so that's really missing that critical opportunity to intervene when those people are taking steps to access sterile equipment. Does that answer your question?

So it's just based on what the person says their need is. Indicates someone came in and said, I need 100, we would just give them 100. Right?

And 100, that sounds like a large number. But particularly our neighbor islands where people have more limited access to the program and they may be visiting the program once a month or once every two months, we currently see numbers like that. So that would be. That wouldn't be an unreasonable amount in a situation like that.

Okay. All right, thank you.

If you could remain there, Members. Any other questions?

Representative so I'm a very big supporter of needle exchange. I love what H3RC has been doing. I've seen them in action. I love harm reduction. I just had a question. So how many providers are out there that are part of this program?

So in terms of access for the various houseless community Members to be able to access these points of contact to get their needle exchanges, how many do we have across the state? Right.

So by statute, there is a single syringe exchange program. It has been statewide for decades. So as you indicated, it's Hawai' I Health and Harm Reduction center that operates a syringe exchange program. The program operates through mobile outreach. So they have vans and individuals going out in response. They have fixed site vans that have fixed routes.

People can also contact by cell phone the syringe exchange worker and schedule meetings wherever they are. And the program currently subcontracts with providers, several providers on neighbor islands to extend their reach. They have some staff of their own on the neighbor islands, but they also contract subcontract with other agencies to start to extend the reach. Thank you.

Thanks.

Thank you. Any other questions? If not, I do have a question. Some of the opponents expressed concern over the fact that passage of this law could lead to needle litter. And I'm curious to know, in the 48 other states that have adopted such a program, has that been a problem?

So the Department of Health is certainly very concerned about this. It is our intent to see more syringes improperly discarded. So that's certainly something we're paying attention to. Just a point of clarification. The fact that there are only two states that limit syringe exchange to one for one doesn't mean that every state has syringe exchange.

So it's not 48 states that have syringe exchange. There are some states that prohibit it entirely. So just as a point of clarification, the available research indicates that that needs based syringe programs are not associated with. With higher rates of improperly discarded syringes.

In, In Hawaii in 2001, we passed a bill to permit pharmacies sales of syringes to prevent bloodborne pathogens. One of the concerns when that Bill was passed was this issue was that increasing access to syringes and whether that was going to correlate with increases in improperly discarded syringes. So that initial 2001 bill had a sunset.

We really looked very closely at any issues with improperly discarded syringes. We really did not see significant issues. So in 2004, the Legislature made that bill permanent. So we have some experience with that kind of increasing access and, and seeing if it had an impact. And at that point it did.

It's certainly something we will be paying a lot of attention to.

Okay, thank you very much. I don't have any other questions, so thank you. Let's move on to SB 1431, Viral Hepatitis, Department of Health.

Tim McCormack again. Communicable Disease and Public Health Nursing Division with the Department of Health. The Department strongly supports this bill as well. Viral hepatitis is a winnable battle.

With very limited resources, we have created a strong community partnership and with the available testing technologies, vaccination for hepatitis A and B, treatment for hepatitis B, and curative treatment for hepatitis C, we have tools to really impact viral hepatitis.

And, and with the small amount of federal funding that we've had and community partnerships, we've demonstrated a number of potential interventions and with some state support, we could really have a dramatic impact on viral hepatitis. Okay, I'm available for questions. Thanks.

Hawaii Harm and Hawaii Health and Harm Reduction Center. Aloha Chair, Vice Chair, Members, Nico Sleavers on behalf of Hawaii Health and Harm Reduction Center Center. As Mccormick. Mr. Mccormick indicated, viral hepatitis is a winnable battle, meaning that we can make significant progress in combating a disease in a relatively short period of time.

And H3RC has been a proud partner in Hep Free Hawaii, which is about 200 community stakeholders convening every month to find out and to discover ways that we can reduce hepatitis in our community. We currently have a plan, Viral Hepatitis Elimination Plan, Hep Free 2030, which I linked to in my, in my testimony.

And we can really make significant inroads on hepatitis, which is significant cause of liver cancer in our state. So I thank you for allowing me to testify and I'd be happy to answer further questions. Mahalo.

Thank you. Also on Zoom, Aloha Care, Mike Nguyen, please proceed.

Morning Chair, Vice Chair, Members of the Committee. Standing on a written testimony in support. Thank you.

In support. Thank you. Anyone else wishing to testify on SB 1431? Members, any questions? Representative Marten.

Department of Health. So the one question I had is, you're eliminating the department's ability to provide medications for newborns of indigent mothers. Is that because those services are. It's obsolete. Those services are being provided by some other provider?

No, the Department. Even without this in statute, the Department has that ability, so it was unnecessary.

While you're up there, I do have a question. The measure proposes educational awareness and prevention programs. Would these be aimed at hepatitis A, B and C or just hepatitis B and C?

Yeah. So really, all of our objectives really focus on hepatitis B and C. But in addressing hepatitis, there's a lot of synergy. In addressing the various types of hepatitis, it's important for people to understand the differences. They might have had, had, have had hepatitis A and think, I had hepatitis.

I don't need to be vaccinated for hepatitis when we're talking about different. Different infections. And so there's education across the board, and often when we vaccinate for hepatitis B, we're giving a combination hepatitis A and hepatitis B vaccination. So really, this program would to some extent address other forms of viral hepatitis other than B and C.

But B and C are really the most critical because they're. Because they lead to chronic infection, liver cancer and deaths. And so really, that's kind of how the objectives are really framed.

Okay, I see. So we don't need to specify hepatitis B and C as the primary targets, then?

We don't think it's necessary. But if you did that, I don't think it would impact how the program operates.

Understood. Thank you very much. Thanks. If there be no other questions. Let's move on to SB 1447, cease and desist orders. Department of Health, good morning again.

Lauren Kim, Department of Health Department strongly supports this administrative measure which authorizes. Well, which requires care home operators who have findings of health and safety and orders to close requires them to not operate during the appeals process. So this is a bit of a loophole.

You know, an inspector or surveyor goes into a care home finds that, you know, there are an insufficient number of fire extinguishers or exits are blocked or there's an insufficient staff to patient ratio and we order them to close. And due process being what it is, you know, they have, they have the ability to appeal.

However, during that appeal process, they can still maintain business operations. And we believe that this is a risk to vulnerable individuals. And, you know, and they, they have the right to appeal. But, you know, we, we have produced findings that these patients are at risk and they should not be allowed to maintain operations during the appeal process.

The appeal process can be lengthy, can take up to a year. And we have cases right now where, you know, about a year ago there, there was an issue of notice of violation and they're still allowed to operate.

So we believe this is a common sense approach to protecting vulnerable populations until they are able to have a, comply with the corrective action plan. So thank you for considering this bill. It's very important for our community, for safety in our community. Thank you.

Okay, thank you. Let's see. That's the only testifier we have on this. Any questions? Anyone else? I mean, sorry, anyone else reading testify? If not, let's move on to the next bill, which is SB 1421, medical records, Department of Health.

Good morning. Chair. Vice Chair, Members of the Committee, I'm Wanda Naonishi with the Department of Health. The Department stands on its written testimony offering comments.

We're concerned that if providers are required to send the medical records, which contains confidential information, to the patient's last known address, that someone else might intercept and access those records other than the patient. So we offer, we recommend that this bill reverts back to its original draft.

Or we offer a compromise that instead of sending the medical records, we send a notification letter with instructions on how to access their medical history. On a personal note, when two of my providers retired, they did that.

They sent me a notification letter with instructions and I just had to make an appointment to pick them up if that was what I chose to do.

So thank you. Queens Health Systems.

Aloha, Chair. Vice Chair. Members of the Committee, we have similar Concerns the Department of Health has. We've also offered up a friendly amendment that we think seeks to strike balance and effectuate the intent of the bill. Happy to answer any questions. Thank you.

If while you're up there, if I can. Well, maybe I just ask you. So the original bill as introduced had this language in it and it was removed by the Senate.

I think it was amended by the. The Senate Health Chair. Yeah. To try to provide some direction on, you know, getting contacting patients and so forth. It just creates a bit of a problem with personal health information and could run afoul of hipaa.

So this is a way to allow the patient to know how to access those records if they want them. Our amendment helps to do that.

So rather than just sending them out to the address, this ensures some kind of. Exactly. Okay, thank you very much. Thank you. Any questions? If not, let's go on to SB 1042, mental health emergency Therapies. Let's see. Attorney General's Office.

Good morning, Chair, Vice Chair, Members of the Committee, my name is Alana Bryant, Deputy Attorney General. Our department's comment is that the proposed Special Fund may not meet the requirements of HRS 375233.

We suggest adding a purpose section to the bill describing the purpose and scope of the program and why it can't be implemented under the General Fund appropriation process. We also note that per HRS. 37.52.3, Special Funds must demonstrate the capacity to be financially self sustaining.

So a financially self sustaining funding source may need to be added to this bill. I'm available if you have any questions. Thank you.

Thank you. We have the Office of Wellness and Resilience, Office of the Governor.

Good morning, Chair, Vice Chair, Members of the Committee, My name is Dr. Trina Orimoto. I'm the Deputy Director at the Office of Wellness and Resilience. We stand in support of this measure and really believe it's an opportunity to provide life saving treatments to a group of Members of our community.

We humbly offer the following amendments for the Committee to consider. First, we recommend amending the language to place the program within the Office of Wellness and Resilience. Second, to address comments from the Attorney General removing language around the Special Fund. And then third, though not labeled in our testimony exactly, we recommend.

We didn't talk about appropriations in our testimony, but believe that if we're matching public funds with private dollars, approximately $1 million per year would be an appropriate appropriation for this project. Thanks for hearing this measure and we're available for questions.

Thank you. Clarity Project Ashley Lukens.

Aloha Chair, Members of the Committee. My name is Ashley Lukens and I represent the thousands of people here in Hawaii who have benefited from legal safe access to breakthrough therapies. At 36 years old, I was diagnosed with brain cancer and was able to access psychedelic treatment to assist my own healing.

The efficacy of these medicines rely on a safe clinical setting, so in order for them to be effective, we need to create avenues and opportunities for Clinicians to be able to use these medicines to enhance the therapeutic process.

We've been at the Legislature now for six years advocating to improve access, and we feel really excited by the Office of Wellness and Resilience Understanding of the efficacy of breakthrough therapies to treat trauma, and we're excited about this bill's capacity to provide patients in Hawaii immediate supported clinical access. So I'm available for any questions.

Thank you very much. Now we have a number of testifiers on Zoom, starting with Lieutenant General Steele. Please proceed.

Thank you, Mr. Chairman, Vice Chair Loy and esteemed Members of this Committee, I am honored to offer testimony on behalf of the Veteran Mental Health Leadership Coalition in support of Senate Bill 1042.

For background, I'm a retired lieutenant General of the Marine Corps, having had the privilege to serve for almost 35 years, starting as an enlisted private in 1965 and retiring in 1999 as the deputy Chief of Staff for Plans, policies and Operations.

I lived in Pearl harbor from 1995 to 1997, where as a major General, I served as the Director of Strategic Planning and policy at the U.S. Pacific Command. As the J5 since retiring from active duty, I have dedicated my career to combating the veteran mental health and suicide crisis that we are undergoing in our country.

Given what has been said by the previous testimony, stakeholder feedback from the Attorney General's Office suggests that the Special Fund is not the appropriate vehicle for achieving the desired ends of this legislation. It is our recommendation that the Legislature consider amending the Bill to utilize a pilot program model.

By incorporating the proposed change, SB 1042 still takes essential steps to ensure Hawaii is prepared to meet this moment by establishing the Mental Health Emerging Therapies Pilot Program, which will support clinical research into innovative therapies Fund public private partnerships to advance all research provide training and education for mental health professionals to prepare them for delivering these therapies safely and effectively establish patient access pilot programs to ensure that those in need, including veterans, have pathways to care and utilize both public and philanthropic contribution.

This legislation represents a bold and necessary step toward addressing the urgent mental health needs of our veterans. By establishing this Fund, we believe that Hawaii can become a national leader in providing access to innovative life saving treatments for those who have selflessly served our country.

I personally appreciate your leadership and stand ready to assist you in any way I can to ensure the success of this important initiative. Thank you Mr. Chair.

Thank you very much, General. Next, we have reason for hope. Jesse McLaughlin on Zoom.

Aloha Mr. Chair, thank you for the opportunity to testify. My name is Jesse McLaughlin. I'm Director of State Policy and Advocacy at Reason for Hope. We are a national nonprofit focused on preparing the medical system in the United States for FDA approval of psychedelic assisted therapies.

Psychedelic assisted therapies like psilocybin and MDMA do not fit neatly into our existing mental health care. They are not take home drugs. They are intensive talk therapy that is supported by a supervised dosing session under the care of licensed and clinical providers.

Quite simply, we do not have a current mental health infrastructure or trained workforce to support equitable access to care after FDA approval.

And so what this bill contemplates and what other states are doing to get ahead of the game and be ready for FDA approval is to begin making investments into workforce development and training through the funding of FDA clinical trials. Not for the purpose of drug development, not for the purpose of subsidizing Big Pharma.

This is for the purpose of training Clinicians and opening up a legal access pathway to patients most in need prior to FDA approval. And so to that end, you know, we would recommend, given the feedback we've received on the way, in which maybe a Special Fund isn't the most appropriate mechanism.

You know, we would look towards, you know, states like Connecticut who have successfully implemented a state backed pilot program. It requires very low operational overhead from, from the agency being able to work with clinical partners.

And Connecticut is going to be well positioned with a trained workforce for FDA approval of psilocybin to the benefit of patients in need. And so we'd be happy to share and answer any questions as to how a pilot program model might work.

But just want to commend the Committee on hearing this issue and urge its adoption and the consideration of a pivot to a pilot program model that we see working in other states.

Thank you very much. Next we have Nico Sleavers, Hawaii Harm Health and Harm Reduction Center.

Aloha Chair, Vice Chair and Members Nicolas Sleavers with Hawaii Health and Harm Reduction center in strong support of this bill. HCRC Executive Director Heather Lusk and I actually served on the Breakthrough Therapies Task Force.

And you know, we're at a critical juncture here with respect to the treatment of post traumatic stress disorder and major depressive disorder. And what this bill would Contemplate is what Mr. Mclaughlin said previously. We are creating sort of an infrastructure of care. So when these therapies are green lit, Hawaii will be ready to go.

And we stand in strong support of this bill. Mahalo.

Thank you. Robin Martin.

Aloha Chair, Vice Chair, Members of the Committee. My name is Dr. Robin Martin. I'm with. I'm an assistant clinical faculty with the Department of Psychiatry at Jepson Medical School and in private practice in Honolulu. And I stand by my written testimony in support of this bill.

And I'd just also like to add that I currently have patients right now at high risk of suicide who have pretty much failed every current treatment available to them in the State of Hawaii who are looking at flying to other countries at great personal expense and great inconvenience to access some of these therapies that really would better serve them if we were able to provide that access to them here in the state.

So thank you very much for considering this bill and I'm happy to answer any questions that the Committee may have.

Thank you. Dr. Christina Rodriguez.

Greetings, Chair, Vice Chair and Members of the Committee. My name is Christina Rodriguez and I am a registered nurse specializing in psychedelic assisted therapy and education living here on Maui in strong support of this measure.

I had the distinct honor of serving on the task force for last year's psilocybin bill and I'm currently on the board of advisors for Clarity Project. I'm trained in the clinical Western medical model in psychedelic therapy and research as well as in traditional indigenous medicine cosmologies to work with psychedelic plant medicines.

I'm also a MAPS MDMA trained facilitator. I've developed and currently teach curriculum in the use of plant medicines from the historical, ritualistic, spiritual and ceremonial perspective in the State of Oregon. As such, I've had the opportunity to learn from and teach some of the brightest minds and hearts in the psychedelic plant medicine field.

Ultimately, I'd like to inform or remind you that while the medicines in question for research funding are considered emerging and breakthrough therapies, science and the medical community are only now substantiating what indigenous communities have known and practiced for millennia.

Psychedelic plant medicines have traditionally been used to help people heal from addiction, trauma, illness and in preparation for the death and dying process, among many other therapeutic applications that nourish and heal individuals and commun communities.

Personally, my own experiences with plant medicines have deepened my empathy, expanded my resilience, and allowed me to process and heal past trauma and PTSD in ways that traditional therapy never could. While not appropriate for everyone, with proper education, regulation and medical oversight, psychedelic medicines can revolutionize mental health care, providing hope and healing to countless individuals in need.

I'm prepared to train and support Clinicians and patients here in Hawaii. Please support this bill. Thank you. And I'm available for questions.

Thank you. Jasmine Gadula on Zoom not present. Dura Ton here.

Aloha Chair, Vice Chair, Members of the Committee. My name is Dura Ton. I'm testifying as an individual but also serve as the project manager for Clarity Project.

We want to just indicate strong support for Office of Wellness and Resilience amendment request, which one will add a purpose to the band it'll change a special Fund to a pilot program which will resolve the comments from the AG's office as well as the Department of Budget and Finance.

And it also simplifies the scope of the pilot program itself in reading through the 111 pages of testimony, just noting that there were no testimony at all in opposition. So just the power of that and the positive benefits that the outcome of this bill would have.

And just to share one example, the therapies that we primarily want to focus on in this pilot program will be psilocybin and MDMA, which have both been granted breakthrough therapy designation by the FDA. One of the reasons MDMA got that designation was because in one of the studies they found a 67% complete resolution of symptoms for PTSD.

So just the groundbreaking nature of the results in these studies is why we really want people in Hawaii to have access to these therapies. Thank you. And available for questions.

Thank you. On Zoom. Lynette Averill.

Hi there. Thank you so much for the opportunity to be here. I strongly support SB 1042. This issue is deeply personal for me. My father, a U.S. marine, died by suicide after years of struggling with ineffective treatments and his life and subsequent death shaped me personally and professionally.

As a researcher and practicing psychologist specializing in ptsd, depression and suicidality, I have worked with many patients who did not find adequate healing through traditional available interventions such as SSRIs, or who found relief only to the point of tolerating existence. I don't believe that is sufficient.

I have led many studies, both as researcher and clinician, on novel rapid acting therapies like MDMA and psilocybin, both of which have been designated by the FDA as breakthrough therapies for their ability to provide safe, fast acting, robust and long lasting relief where traditional treatments fall short.

I can tell you firsthand this legislation is timely, important and feasible as I have the great opportunity of leading the Texas program, House Bill 18 that passed in the 87th legislative session which funds a psilocybin trial for veterans with PTSD.

And while we have just started dosing for this trial, we have had literally hundreds of veterans come forward saying that they are desperate for something that may work, and hundreds of other people, non-veterans, come forward saying the same thing. And I will say that the results are nothing short of remarkable thus far.

Importantly, I will note also that not only are we treating individuals who have not found healing elsewhere, we are creating a groundswell in terms of professionals who have training and budding expertise in administering and facilitating these sessions in a safe, ethical and medically supervised way.

Certainly, I think these interventions represent a bit of a paradigm shift in how they are done, which is likely how and why we're seeing the results we are. I will note that most Clinicians are not going to be like Mr. Rodriguez, who spoke just a moment ago, who have significant background in these interventions.

Even incredibly well trained and skilled Clinicians and providers do not have training in these interventions. And it is critical that Hawaii take steps to pioneer this work on the island and build more people like Ms. Rodriguez who would be able to provide high quality care in the space. Thank you.

I think the other point I would make very briefly is just that it's critical to explore pilot programs like this to support patients in accessing these. Now, prior to FDA approval, we must consider undertreated or untreated mental health concerns as life threatening illness, just as we would a cancer diagnosis, because that is the reality.

Funding a pilot program like this ultimately will be saving lives as well as providing that opportunity to build infrastructure now. Thank you Connecticut Elsewhere urge you to pass. It would be incredibly important.

Thank you. Edith Garcia on Zoom.

Aloha. My name is Edith Garcia and I'm a Navy veteran. I traveled from Hilo to Testify today for SB1042. Like many service Members, I struggle with PTSD, anxiety and depression. Instead of healing, my experiences within the VA system led to further trauma and desperate for relief, I sought treatment overseas where I found hope.

I am alive today because of those therapies. Despite anyone's opinions on psychedelics, SB1042 is a vital step towards expanding evidence based treatments including psychedelic therapy which has shown in men's promise for mental health condition affect affecting veterans. The science this part is clear and now it's time for Hawaii to lead in providing safe, regulated and effective options.

No veteran should should leave their home to access life saving care. I fought for this country and now I ask you to fight for veterans right to heal here in our homeland. Please pass SB1042. Mahalo for your time.

Thank you. Erica Manzano on zoom.

Good morning chair, Vice Chair and Committee Members. My name is Erika Manzano and I'm here to ask you to support Bill SB 1042. I'm a veteran with PTSD, the wife of a veteran with PTSD, and most importantly, a mom. I'm also a survivor of childhood sexual trauma as well as military sexual trauma.

Without the therapies and practices proposed in this bill, I would not be where I am today. The events of my childhood and military experience left me afraid of the world, riddled with anxiety and blanketed in depression.

All of these combined left me unable to connect or feel for anything or anybody around me, including my own daughters who desperately needed me. I tried many different therapies with very little results.

Three years ago, I was privileged enough to travel out of the country to Mexico to receive healing with the use of these therapies proposed in this bill. There are no words that could effectively express to this committee just how transformative this journey has been for me and my family.

Those therapies helped me feel deeply for the first time and reconnected me with my daughters in a way I never dreamed possible.

Now, as I support fellow veterans on their own journeys, I see the same hope rekindled in them and wish to make these therapies more accessible and affordable within our own country, not just for veterans, but also the people of Hawaii.

I implore you all to consider the profound impacts these therapies have had on the lives of those who've experienced their restorative powers, and together we can champion a future where healing is within reach for all who suffer. Please support SB 1042. Mahalo for listening.

Thank you. Robert Farmer not available on zoom. Josh Sze, Please proceed.

Maloha My name is Josh Sze. And I'm a disabled veteran who has battled PTSD, depression and anxiety for years. My struggles led me to homelessness and I was lost in the VA system that offered me no more than medication. Nothing worked. More days than not, I didn't care if I woke up.

I found out about plant medicine and that the treatment absolutely changed my life. It helped me confront my trauma in a way that traditional therapies never could. It allowed me to break free from the cycle of despair and rebuild my life.

Today, I am no longer homeless and I am about to graduate with a bachelor's degree in psychology from UH, Hilo, something I never thought possible. This therapy gave me a second chance. Plant medicine has the power to heal and should be accessible here in the United States.

It is completely unacceptable that we must travel outside the country for healing. This is more than just a bill. It's a lifeline. It's a chance for veterans and others suffering from mental health conditions to to access a treatment that can truly heal.

I urge our lawmakers to support this bill and give more people the opportunity to reclaim their lives. Mahalo.

Thank you Amanda Lily Bridge and strong support. Thank you. Vicky Farmer.

Aloha. My name is Vicky Farmer. I flew in from Kona this morning to be here. I am a military spouse. My husband served in the US army for 22 years. He completed 10 combat deployments as a Special Forces Green Beret. He left the VA on 13 medications that left him feeling like a zombie.

We tried many therapies that barely scratched the surface. Several years ago, we found ourselves in crisis, a place no one wants to talk about. No one wants to face suicide. My husband survived the war abroad, but almost lost the war at home.

That same year, there were many headlines about psychedelic medicine and veterans, and truth be told, I thought it was crazy. I was very skeptical, but I remained open. I delved into the research, documentaries, podcasts, articles, study after study, and came across Vet Solutions, a nonprofit started by Marcus and Amber Capone to support veterans and their spouses.

My husband and I applied and received a grant to access plant medicine outside of the country. For the first time in years, my husband experienced profound relief. It wasn't a miracle, it wasn't an overnight fix, but it was a catalyst to his healing. It gave him neuroplasticity. It gave him space to breathe.

And most importantly, it gave him space to process his trauma. Because here's the truth. Post traumatic stress doesn't just affect the veteran, it affects the entire family. We also carry the weight of the war. But healing ripples out. It spreads through the family like a wave rolling through the ocean. As a spouse, I've witnessed this firsthand.

My husband served this country for over two decades. Yet to find safe and effective treatment, he had to leave the country. This is unacceptable. We know that there is a better way forward. We know there is light, there is hope.

And I ask you today to take that light as a beacon into this legislative era and pass SB1042. Mahalo. Mahalo, Mahalo for allowing me to talk story.

Thank you, thank you, thank you. Anyone else wishing to testify on SB1042, please step forward or on zoom. On zoom. Yeah. Please proceed. Tell us who you are.

I'm Mary Healy. Thank you for hearing my testimony. I am just so moved by the testimony that was given for this particular bill that I feel that I have to also show my support. Whether it's pilot program or whatever way each of you sees fit to move this forward, it needs to happen.

Plant based medicine is effective at treating numerous mental health issues. Like she said, it can give people back their neuroplasticity. It can change people's lives for the better. And all of you, you have a respons responsibility. You know it's a Kuleana. Yeah, it really is.

To make Hawaii a place where our veterans and other individuals who are suffering from conditions that can be healed with this medicine, a safe haven. And I just so grateful that I could be here today to show my support for this. And please, please, please vote yes. Move this bill forward. Let's save lives.

Let's create a better world for everyone. These plant based medicines have been around for a long time and they have historically through human history, benefited the human race. It's just very unfortunate that they've been demonized in the ways they have been.

And we can do amazing things for our people by bringing these kind of medicines into the health care field. Yeah, that's basically what I want to say. The health care field and eliminating some medicines that are known to be toxic. Thank you so much for hearing my testimony.

I'm sorry that I just jumped in like this, but wow, what an amazing day. I hope you all vote yes on this bill.

Thank you. Anyone else wishing to testify on SB1042? If not members, questions for our testify cars represent.

For the Office of Wellness and Resilience. Please.

Chair. So I'm very. Raise my hand.

I'm sorry, Mr. Kulbis. Okay, why don't you proceed? I'm sorry.

Yeah, I'll be. I'll be very quick. As a 22 year Navy veteran, I fully support this program. I'm astonished that it's taken this long for the Hawaii Mental Health and Department of Health to do this because the issues with mental health of our service members is vital to our national security.

And so I fully support this and strongly encourage you to vote yes on this bill. Thank you.

Thank you very much. Okay. Last call for testifiers. Seeing none. Representative Marten.

Thank you. So I. So is this therapy, which I'm very supportive of, is it only available through a clinical trial, given its breakthrough status? I'm confused by the pilot program and the clinical trial. They don't. They seem a little bit mutually exclusive to me.

Sure. So our. Based on our proposed amendments, the pilot program would consist of the research study, education and training, and also the report at the end of it.

But the research study is the biggest crux of the pilot program and would then be under all of the necessary supervision of the DEA and institutional review boards and have all of those controls. But that would be the primary effort of the pilot program.

So then as a follow up, you know, I used to work for a clinical trials program. It's not something. It's not like just providing a service. Right. Where who has the expertise within Office of Wellness and Resilience to run that?

That is an excellent question. And our plan would be to really work with stakeholders and Committee Members to identify an organization that would be able to do that, like in a University setting or another organization that has that capacity. Capacity and expertise.

Thank you. If you could stay up there. I do. I'm sorry, did you have a question? Okay. If you could stay up there, I have a question. Following up on your testimony, tell me again how much money you're requesting or suggesting for this.

Yes. So in following with other states prior efforts, we're asking for $1.0 million and proposing and with help from our collaborators that we would find an additional $1.0 million in private funds to support this project.

$1.0 million per year?

Yes. Yes.

Subject to matching funds?

Yes. Correct. Correct.

And a two year pilot program is. Okay. Okay. Any other questions? If not, let's move on to our final bill on the agenda. SB 1432, establishing a Universal Immunization Fund. Department of Health.

Aloha chair, vice chair and members of the committee. My name is Nathan Tan. I am the Deputy State Epidemiologist in the Disease Outbreak Control Division. The department stands on our written testimony and strong support of SB 1434 SD1.

By centralizing public and private sector immunization procurement within the Department of Health and leveraging bulk purchasing power through federal or state consortium contracts, this initiative will lower private sector costs and improve access to needed immunizations for all keiki, families, communities and healthcare providers statewide.

We request several amendments to clarify the program structure, assessed entities, fiscal management and available brand choices. We will remain available for questions. Thank you very much.

Thank you. Tax Foundation of Hawaii on Zoom.

Good morning, chair and members of the committee, this is Jade McMillan on behalf of the Tax Foundation. We submitted some comments on the measurement. In our comments, we noted that we feel that the new special fund program do constitute a new tax on health insurers.

So we generally don't agree with this new tax and we feel that establishing that special fund is inappropriate. So we would really question the need for this particular way to finance the program. Thank you.

Okay, thank you. Also on Zoom Aloha Care, Mike Nguyen.

Good morning again, chair, vice chair, members of the committee, Mike Nguyen, Public Policy Director for Aloha Care we submitted written testimony and we want to stand on that. Just adding in addition to the good public health measure that this is, we've heard from our community providers that accessing and purchasing immunization or vaccines is challenging.

And so for those reasons we do want to improve access to vaccines. Thank you.

Thank you. Also on Zoom Biotechnology Innovation Organization, Brian Warren.

Aloha, chair and members, my name is Brian Warren and I work for Biotechnology Innovation Organization and our members represent companies that manufacture and research and develop new vaccines.

I want to make clear at the beginning that we are a pro vaccine organization and we fully support robust immunization programs and our concerns are in no way a reflection to immunizations in Hawaii or anywhere else.

Our opposition to this bill is based on concerns that UP programs can limit provider and patient choice when it comes to which specific vaccines are available. They can disrupt supply chains and they have not been shown in states where they have been enacted to actually increase immunization rates.

We would like to work with the Department of Health on identifying more precision tailored solutions to concerns with vaccine access and infrastructure in Hawaii, whether those are about provider reimbursement rates, ensuring all qualified providers are able to vaccinate, whether it's the cost of procuring vaccines, et cetera.

I did see the amendments this morning that the DoH is proposing, but we have not had a chance to evaluate them.

I don't think that they would change our overall position on the bill at this time, but overall we really feel that this bill represents a significant shift in vaccine policy for the state and should be examined further along with other available policy options before passing. Thank you.

Thank you. Hawaii Christian Coalition on Zoom.

Aloha, my name's Margaret Mejia and I'm here on behalf of Hawaii Christian Coalition. We have approximately 35,000 members and I represent about 130,000 people, including their spouses and children. SB 1434 would create a universal immunization funding program to buy vaccines in both and distribute them to health care providers.

However, this program is not necessary since we already have Vaccines for Children, a federally funded program that provides free vaccines for eligible children. SB 1434 contains no spending cap and the wording in this bill is ambiguous and vague. This bill leaves out important details, especially about the ongoing cost of this funding program.

This bill has a special fund, page six, line 17 and 18, which includes an undisclosed amount of fees, fines and cost reimbursements. This bill also lacks information regarding the assessed entities, page 6, line 19 who are funding this special fund? How much money will these health care providers contribute?

This is only one of the many questions this bill poses. There's also no wording about the people's choice to vaccinate or not. There's no wording about informed consent. And page six, line two gives Dr. Fink, the Director of the Department of Health, the authority to order any substance, including MRNA as an immunization.

Although the wording MRNA was removed from the first SB 1434, it's still a substance that can be used in immunization. According to SB 1434, Senate Draft 1, Page 6, lines 1 and 2, MRNA is a dangerous substance and according to Dr. Robert Malone, M.D.M.S a biochemist and biologist and creator of MRNA technology, MRNA changes people's DNA.

SB 1434 would give Dr. Fink, head of the Department of Health authority, without liability. If there are injuries and or deaths due to these unspecified vaccines on the unspecified vaccine schedule, there's no liability. In addition, health insurance companies do not give free medical and there will be costs for services to children and adults.

The people of Hawaii deserve to decide what goes into their bodies and their children's bodies. Since Hawaii state government is expecting federal cuts, can we afford another program to be added to our existing programs that we still have to fund? Thank you very much.

Thank you. Brett Colbus on Zoom.

Thank you, chair, committee members. My name is Brett Colbus 26 year Navy veteran living in the beach. I strongly oppose SB 1434. Funding mechanism proposed by this bill is problematic. By levying assessments on health insurers, the bill will lead to increased costs for Hawaii families through higher insurance premiums.

This regressive approach disproportionately burdens those already struggling with Hawaii's high cost of living. The bill grants excessive and broad discretionary power to the Department of Health to impose interim assessments during vaguely defined public health emergencies. This lack of oversight could lead to unchecked financial extraction from insurers and ultimately consumers.

The centralized approach to immunization procurement and distribution undermines the autonomy of healthcare providers providers of patients by mandating state supplied immunizations and disallowing providers when using private stocks. This bill replaces professional judgment and patient choice with a one size fits all model. The bill also fails to include a spending cap or clear budget predictions.

This open ended financial commitment could strain state resources and potentially divert funds from other critical health initiatives. The creation of another special fund violates sound fiscal policy recommendations and goes against the recommendation of the 1989 Tax Review Commission, which stated such funds restrict budget flexibility and reduce accountability. I encourage you to vote no on SB 1434, mahalo.

Thank you. Cheryl Toyo Fuku.

Good morning. Aloha representatives. My name is Cheryl Toyofuku. I'm a mom, I'm a grandmother. I'm a retired registered nurse. And 30 years ago I did transition to more natural and non toxic health care. I am in strong opposition to SB 1434 relating to the universal immunization funding program.

And it's allowing the Department of Health to manage the purchase and distribution of immunizations without a really projected budget and clear funding proposal. And that's terrible fiscal policy. Establishing a special fund to purchase vaccines for future use appears inappropriate as it would impose a new charging cost on health insurers and health plans.

Are these assessed, so called assessed entities? Are they the health insurers like HMSA, Kaiser, Tricare? This will result in higher health premiums for the policyholders. Also in the assessment section of the bill, the director may determine an interim assessment for new immunizations or public health emergencies. They can administer and expend the monies of this special fund.

And this seems to be an overreach of power that may include experimental, unsafe and ineffective vaccines without any public or legislative oversight. So and plus inserting legal immunity for the Department of Health with no liability in managing and operating this universal immunization funding program is very concerning.

It may lead to unethical and questionable practices with possible vaccine mandates. We don't know. But this would be. I would. Since Attorney General is here, this would be a thought. I mean what is this legal immunity something that he might want to address?

You know, funds should be allocated instead towards and priorities of healthier programs and lifestyles that build our natural immunity. I appreciated hearing the previous bill and immunization programs should be avoided as we are aware of increasing significant scientifically documented research linking toxic vaccines to to neurological disorders, crippling diseases and increasing chronic illness.

The VAERS or the Vaccine Adverse Event Reporting System and vaccine death reports can verify this. So please oppose SB 1434. Thank you.

Thank you. Terry Armbruster? Not present. April Lee. Nope, not present. Dr. Cassandra Simonson on Zoom.

Hi there. My name is Dr. Simonson. I'm a pediatrician in Maui where I've worked with the underserved and native Hawaiian keiki for over 10 years. I'm speaking today on my own behalf and not representing anyone else in strong support of SB 1434 to establish a state immunization funding program.

I'm supporting this because I don't want to see any keiki sickened or worse die from a preventable infection. With the uncertainty at the federal level and the growing measles outbreaks across the country. It is imperative that Hawaii shore up our public health defense and secure our own supply of immunizations.

We may not be able to rely on the federal government to supply or pay for them much longer. For the VFS, through the Vaccines for Children program, we've already seen many outbreaks. And in my own- in my own area, only around 35% of my children, my patients two years and under, are fully immunized. The vaccine refusal rate has just skyrocketed.

Nobody likes to be told what to do, and that's understandable, but we are really in a desperate position on the neighbor islands. I think that I've looked at the DoH data on the neighbor islands and there's around 4,200 students with religious exemptions just in the schools on the neighbor islands with measles.

Assuming those people who have religious exemptions did not want MMR vaccine, you would have 4,200 students vulnerable. 20% of measles cases are hospitalized. That could mean up to 840 hospitalizations just on neighbor islands. There are no hospital beds on the outer islands.

And if cost is your concern, you know, an ICU bed is at least $8,500 a day transport from inner island, we're looking at $30,000. The death rate, if you don't have that excellent healthcare from measles at that number of neighbor island, unvaccinated kids would be around at least four deaths on the neighbor islands.

And even with the best medical care, assuming you could transport everyone to that highest level ICU, if you don't, if you have no medical care, you're at a 15% mortality rate with measles. And that's what happened in Samoa, why so many children died. They didn't have high level care.

With that number on the neighbor island, you could see upwards of 630 children die from measles, which is what it used to be like. With that, I'll stand on my written testimony. Otherwise. Thank you.

Thank you, doctor. On Zoom, Commissioner Melendrez, not present. Mary Healy, on Zoom. Mary Healy?

Hi. I'm sorry, it took a minute to connect. Mary Healy, I stand in opposition to this bill. I have a problem with the State of Hawaii for a number of reasons. The fiscal responsibility, the fact that there's a majority of the citizens of Hawaii who are greatly concerned and throughout the nation.

77% of the nation at this point does not trust the CDC. And I just want to read you a recent article from Children's Health Defense, Hawaii religious exemptions and measles. Will the playbook work again?

This article basically came, came to me when I was researching this particular topic and it talked about how California in 2015 and New York in 2019 abolished the right of religious exemptions. The State of Hawaii is overreaching, pushing these vaccines onto people, especially when a lot of these vaccines are toxic.

They cause irreversible, so sorry, irreversible health consequences. And it comes from in the wake of recent measles outbreaks. I understand the concern with measles. Maybe we can enlighten the community about measles in particular.

But that doesn't mean that we should be funding all of these vaccines with just the director of health kind of acting as a czar or, you know, the ultimate decider of what people should be required to put into their bodies in this state. And you know, Hawaii is a very special place because we have the Hawaiians here.

We have a population who have been underserved and have been historically not taken care of. And a lot of these vaccines cause things like how about infertility?

So why are we going to fund the extermination potentially of a race of people and that if that goes out to everyone who's being forced, child or adult, to potentially who could be forced to take these vaccines.

Thank you. I ask you to summarize, please.

Yeah. In summary, I'm 100% against this bill. I think you all should vote no. I think there's so many reasons that other testifiers said that make it just easy to vote no on this.

Thank you.

And I hope- I hope that each of you will look into the children's health discussion. I became acquainted with it.

Thank you very much. Anyone else wishing to testify on SB 1434, on Zoom or in the room? If not, members questions? I'm sorry, did you wish to testify? Please step forward and tell us who you are.

Hi, I'm Terry Armbruster, an Air Force veteran and tax paying resident over 35 years. And I strongly oppose SB 1434 for a number of reasons. First, the funding. Taking, taking money out of the General Fund just to create a special fund is fiscally irresponsible. I even looked up in the text Tax Foundation of Hawaii.

They said this is unjustifiable. And also the stated purpose of this program was to help people that can't afford the shots. Well, have you even asked the people, do they even want the shots? What if they want another healthier alternative?

And so that does not justify spending millions of our taxpayer dollars for a- for a program that the majority of taxpayers did not even ask for and do not want. And also giving the director of health sole authority to run this whole program with. Can you change the rules at any time? Change the assessment fees and fines?

This sounds more like a dictatorship and a financial nightmare. And also there's healthier solutions. What if more people would rather just have free vitamins or nutrient products or more natural solutions? So without freedom of choice, that's also unconstitutional. And I also want to point out that what this really seems to be about is about not about health.

It's about big pharma wealth and government greed, power and control. So I strongly urge you to stop this scam program and vote no to SB 1434. And I also pray that each one of you would seriously consider all the implications of this and get on the right path.

Are you going to face God's wrath for forcing shots upon people that do not want it? Especially if there's harm or death caused by these. So thank you for allowing me to testify to the truth. And the truth will set you free. Thank you.

Thank you. Anyone else wishing to testify, please step forward.

Aloha. My name is Kim Cordery. I am a part of Aloha Freedom Coalition that represents 21,000 members. Not members actually followers. I am strongly opposed to 1434 for multiple reasons that were stated already. But first of all, this is a bill that has been proposed by Josh Green.

I'm not sure if you're aware, but Josh Green was actually unofficially or illegitimately inaugurated. I'm not sure if you're aware of that, but--

Can you stick to the substance of the bill please.

Okay, this to me is relative because this bill has been proposed by Josh Green and he- he was illegitimately inaugurated.

I'm gonna ask you to please stick to the substance of the bill which is establishment of immunization fund.

I am- I'm adamantly opposed to this because I- I believe this is an agenda on his part. And just some questions that I would ask. What 14 states have adopted the Universal Immun- Immunization Funding Program. 36 states have not adopted such a funding purchasing program. Why?

I would hope you're asking yourself why and who is funding the Universal Immunization Special Funding program. According to SB 1434 assessed entities, health insurers in the state that is not federally funded. So does that include HMSA? This was earlier spoken of, included HMSA, Kaiser, Tricare, et cetera. Who is funding these- these programs? I am completely opposed to this.

And going back to my issue with Josh Green not being inaugurated. He was inaugurated prior to the election being certified. That is the reason why he is illegitimate. Thank you.

Thank you very much. Last call for anyone wishing to testify. You already testified. Thank you. Anyone else wishing to testify? If not, members, any questions? Vice chair. Oh, sorry. Okay. If not, let's go. Move on to decision making. I appreciate all the testifiers and members for the discussion. First bill we have is SB 1441.

Transition of the Oahu Regional System from from the HHSC to the Department of Health. I do want to advance this bill to disengage DoH from operating Maluhia and Leahi hospitals.

But I think we do want to ensure that we utilize Leahi Hospital as a care facility for state hospital patients who are stable enough to be discharged, but have no other place to go.

So with that in mind, I'd like to move the bill forward, but also include the DoH and Oahu system proposed amendment as a new part four. Also adopting technical amendments for clarity, consistency and style and also inserting a defective date, July 13,000 Members. Any questions or comments or concerns? If not, Vice Chair for the vote.

Thank you, Chair. Members voting on Senate Bill 1441. Senate draft to chairs recommendation. Recommendation is to pass with amendments. Chair votes Aye. Vice Chair votes aye. Member Amato, Member Chen, Member Martens, Member Olds, Member Takenouchi, Member Alcos, Member Garcia. Thank you, Chair. Your measure has been adopted.

Thank you. The next Bill is SB 1443, providing a pathway for discharge state hospital patients to possibly enter the community via private facilities. I'd like to move the Bill forward. It currently has defective date. I'd like to adopt a House draft to make it effective upon approval. Any questions or comments? If not, Vice Chair.

Thank you, Chair. Members voting on Senate Bill 1443, Senate Draft 1. 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. This next Bill, SB 1322, is an important bill that basically clarifies and and expands all of the statutes relating to mental health and how we treat those who are undergoing mental health and substance abuse problems. It does clarify, most importantly, the procedures for police who encounter people with mental health and substance abuse problems.

And what it does is clarify that they not immediately go to jail, but also not necessarily to the ER either. And it does so by involving mental health emergency workers to make that determination. So I definitely want to move this forward. I'd like to adopt the amendment proposed by Queens Health system on page 8 relating to 1334.

Also like to adopt their suggestion that we change the bill from 72 hours detention to 48 hours. I'd like to adopt the Attorney General's amendment on immunity from liability for emergency workers. I know that's been subject to discussion.

I do want to move this forward though, so that the next Committee, which is the Judiciary and Hawaiian Affairs Committee, so you know they have the legal experts and I'd like to have them discuss this in more depth. Finally, technical amendments for clarity, consistency and style. That's it. Members, questions? Comments? If not, please. Chair.

Thank you, Chair. Members voting on SB 1322, SD2. Chair's recommendation is to pass with amendment with amendments noting all Members present. Any Members voting no. Any with reservation. Chair, your recommendation is adopted.

Thank you. SB 1422 relating to the Vital Statistics Modernization Fund, which is vital. Like to move this forward with the House draft defecting the date and and in the report Committee report. Note that the amount that is expected from these fees is $625,000. Any questions or comments, Representative Amato?

Thank you, Chair. I'll be voting with reservations while the Department of Health is okay with the proposed funding of 340,000 in HB300. I want to note, however, that the House does not concur with item HTH560.

And then I also note that under hrs 321.421, the program is required to publish its data and yet there is still nothing since 2011 and that last publishing was based on 20 year old data. That data is critically important for public health programs.

So I'm again requesting that the children with special health needs bring branch under DOA to follow that law. So I'm voting with reservations to keep the discussion alive and to make sure our state teratology birth defect data collection is adequately funded and reported as law requires. Thank you, Chair.

Thank you. I appreciate that. Representative. Vice Chair for the vote.

Thank you, Chair. Members voting on SB 1422 SD1. Chair's recommendation is to pass with amendments noting all Members present and Member Amato voting with reservations. Any other Members voting with reservations? Any Members voting no? Thank you, Chair. Your recommendation is adopted.

Thank you. SB 1433 relating to harm reduction. I do believe that this measure advances a safe needle exchange program. So I'd like to move it forward with technical amendments.

Also on page 11, a small change on that page on line 6 and 9, changing or to and which I believe is the intent of the measure, which is that none of these subsections should apply. Also add a defective date. Questions? Comments?

Brief comment.

Again, Representative Amato.

Thank you. Chair, I want to thank you for hearing this Bill and for advancing it. This is critically important to the Maui AIDS Foundation. It's one of their high priorities. So thank you. Chair thank you.

Vice Chair. I'm sorry. Representative Garcia thank you.

Chair I don't believe that handing out fresh needles to those with substance abuse is the right thing to do. Similar states and cities that have implemented policies such as this today are littered with needles such as San Francisco, Philadelphia, Baltimore, Portland. The list goes on and on. I believe that we should empower those who.

Who are who are in substance abuse by focusing on treatment and funding treatment, not enabling them by providing these resources to continue in their addiction. So I'll be voting no. Thank you.

Thank you. Any other? Representative AOS thank you. Any others? If not Vice Chair for the vote.

Thank you, Chair. Members voting on SB 14333 Senate Draft 2. Chair's recommendation is to pass with amendments noting the no votes from Member Alos and Garcia. Any other Members voting no. Any with reservation. Chair your recommend? Oh, Mr. Olds's reservations. Chair, your recommendation is adopted.

Thank you. Next Bill is SB 1431 relating to viral hepatitis. We previously heard this in a House Bill 1112 and I believe the merit of the bill still exists. So I'd like to move this forward as a House draft for the defective date and also in the Committee report language.

Note that the requested amount from the Department is $827,844 to provide staff and implementation Members. Any questions or comments if not Vice Chair.

Thank you, Chair. Members voting on SB 1431 SD1 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. This next Bill, SB 1447 is an Administration Bill relating to cease and desist orders issued by the the Director of. Health. And it basically just says that they should these orders should take effect even during an appeal period. I really don't see any controversy over this bill. I'd like to move this forward.

It has a clean date, so I'd like to pass this as is. Questions? Comments? Vice Chair for the vote.

Thank you, Chair. Members voting on SB 1447 Chair's recommendation is to pass as is the noting all Members present. Any Members voting no. Any with reservation. Chair, your recommendation is adopted.

Thank you. The next Bill, SB 1421, relates to medical records and ensures the proper disposal of patient records when a health care office closes. I'd like to move this forward as a House draft adopting the amendments suggested by Queens and Department of Health and also adding a defective date. Questions? Comments? If not, Vice Chair for the vote.

Thank you, Chair. Members on SB 1421, SD1 Chair's recommendation is to pass with amendments noting all Members. Any Members voting no. Any with reservation. Chair, your recommendation is adopted.

Thank you. This next Bill, SB 1042, establishes mental health Emerging Therapies Special Fund. You know, frankly, I've wrestled with this Bill. Given the state's financial situation, now is really not the time to start any new programs that require substantial appropriations. But I also believe we owe something to the military veterans who.

Who are undergoing PTSD and other traumas. And I'd like to offer them the program that offers the opportunity for mental health therapies. So I'd like to move this forward as a House draft, adopting the proposal of the Office of Wellness and Resilience as a two year pilot program and putting an effective date.

Also in the report language noting that the requested amount is $1 million a year for the next two years. Questions? Comments? Members?

I just want to say thank you, Chair, for, for moving this bill forward. It's personal to me. I had to leave the room. Thank you for your very powerful testimony. A good buddy of mine, we dodged the bombs and the bullets in Iraq and came home, and he lost that battle later on. So thank you.

Thank you. Any other Members, if not Vice Chair?

Thank you, Chair. Members voting on SB 1042, SD1 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. Our final Bill, SB 1434 relating to universal immunization. You know, we considered this bill previously as House Bill 1112. I believe the need still exists, and I think this measure is still warranted. So I'd like to move this forward to make vaccinations accessible and affordable.

Move this forward as a House draft with technical amendments, also adding an effective date and in the report. Oh, and also adopting the amendments suggested by the Department of Health. Finally, in the Committee report, note that the suggested amount requested by the Department of Health is $934,000 to start up this special Fund. Members, questions? Comments? Concerns? Concerns?

If not. Vice Chair for the vote.

Thank you, Chair. Members voting on SB 1434, SD1 Chair's recommendation is to pass with amendments noting all Members present. Any Members voting? No.

No vote.

No vote.

Okay, guys. Thank you. Any with reservations? Thank you. Chair. Your recommendation is adopted.

Thank you. We're adjourned.

SA.