House Standing Committee on Health

Hi. Good morning. Good morning, everyone. Thank you for being here. Welcome to the State Capitol and this Joint Hearing on the House Committees on Health and the Committee on Human Services and Homelessness.

On behalf of myself, Greg Takayama, Chair of Health, I'd like to welcome Chair of Human Services and Homelessness, Representative Martin, as well as Vice Chair of the Health Committee, Representative Leoy. So a few housekeeping measures. Housekeeping steps. Just want to remind everyone that in order to allow as many people as possible to testify, we will.

We do have a two minute suggested time limit on each testifier. Also, for those on Zoom, please keep yourselves muted and your video off while waiting to testify. And after your testimony is complete, if you are disconnected, you know you can attempt to rejoin the meeting.

And if we are disrupted by a false alarm or a real alarm, as has happened in the last few weeks, you know we may have to recess and reconvene. Please refrain from any profanity or uncivil behavior, although I don't probably need to say that. But please act with aloha.

First up on our agenda, or our only measure on the agenda for our Joint Hearing is SB 1442 relating to mental health services for children adolescents. And we have the Hawaii State Department of Health.

Good morning, Chairs Takayama and Marten. Vice Chair Keauho Kapuliloi, Chair Member Chun. I'm Kaylee Okwaro. I'm the Administrator for the Child and Adolescent Mental Health Division. I'm here to testify in strong support of this bill which would update our statute.

The statute is 50 years old and still describes us as a branch of the Adult Mental Health Division. So this update would really allow the statute to describe how we currently function as the state's Medicaid provider of intensive mental health services for children and adolescents with serious emotional disturbance.

I also wanted the opportunity to address the request from the Committees on Judiciary and Ways and Means to evaluate the statutory Amendment in Section 3. In addition to the written testimony's caution against establishing an unfunded mandate, I also wanted to add that the language in the statutory amendment is consistent with Hawaii Revised Statutes 3343.

Under the functions of the Department in mental health, there is the language that states that it's within the limits of funding resources. So the amendment is consistent with other statutory language. But I do also feel like it's necessary given the uncertainty of federal funding. Right now, we rely on federal funding to sustain our service array.

So an unfunded mandate would pose a risk to the state. I really appreciate the opportunity to Testify and I'm available if there are any questions.

Thank you very much. We have written testimony from the Hawaii State Council on Mental Health, Office of Wellness and Resilience, Office of Hawaiian affairs, as well as the Hawaii Substance Abuse Coalition, all in support. Anyone else wishing to testify on Senate Bill 1442? Seeing none. Members, any questions? Seeing none.

I think we'll hold off on decision making on this measure to occur after the we hear all the measures on our 9:05 a.m. Health Committee hearing, if that's okay with the Chair. Okay, so let's move straight into our 9:05 a.m. hearing. And we begin with Senate Bill 479 relating to able savings accounts.

First up, we have the Hawaii State Council on Developmental Disabilities in support. Hawaii Disability Rights Center.

Yes, thank you. We're in strong support. Chair ABLE is a great program and the DD Council has done a great job trying to do outreach. But they could really use some more help because this is a wonderful program. So please support the bill.

Okay. Kaili Swan, also on Zoom.

Not present. James Labry, in person. Not present. Hawaii State Council on Developmental Disabilities. Good timing.

Apologies. Hi. Thank you. Daintry Bartoldus, Executive Director for the Hawaii State Council on Developmental Disabilities. Thank you. Chair. Vice Chair. Excuse me. Rushed over. We're in strong support of this measure. This especially during this climate, we where Medicaid is in jeopardy of being lost by many of our people.

If you have over $2,000 in the savings, you will lose it completely. So it doesn't even matter what the matching funds would be. You could lose it completely.

So this is a really good opportunity for family Members and friends to be able to contribute to an individual with a disability to a savings where they can continue to receive the supports and services they need. An able account is just one way where they could save up to $100,000 without affecting anything, which is really super.

Now we're asking just for one staff and there's over 100,000 individuals that could qualify for an ABLE account. Right now we have about 200. When we had an intern from the Department of Labor and Industrial Relationships. That intern worked with us for three months, took about a month to train her.

In two months time she was able to open up and able help 28 people open a savings account. So we know this could work. The staff would educate other entities, agencies to do it. So it would take more than one person, but one person could ignite it to help everyone do it.

Thank you so much for this opportunity to testify.

While you're up there, let Me ask you. I know you're asking for one fte. Is there also an amount of appropriations that you're requesting? And what is that?

Yes, we're looking between 50,000 to 100,000 for incentives. So what? It was, especially with the DOE, for students to open up at a young age, able Savings account where they could continue to add to it. So we're looking at working with the Department of Education for.

I just needed. Did you say. You said between 50 to 100,000? Correct.

Okay, 75,000.

Okay, let's split the difference. 75,000. Thank you, Dietrich. James. Thank you, Labri. Would you like to testify? Yeah. Can you. Won't you come up to the table and you can use this table mic. Thank you very much. We can hear you, but we want to make sure people who are listening on Zoom can. Can hear as well.

James, please proceed.

Good morning, Chair, Vice Chair, Committee Members, my name is James Lapree. I am in strong support of SB479 because I am an individual that receives Social Security.

But I feel that this Able Account Bill, if we hire someone that can teach individuals with disabilities to open an able Savings account like me, it would help us keep our benefits on top of our Social Security, and we would not have to worry about losing our Social Security benefits. And not only that, we could.

It could keep us from anything harmless, like maybe even losing our placement in the home, because it will also not only affect us as individuals, but if the caregiver doesn't get paid, then it may be a struggle for them because they're putting their lives down to take care of individuals like us, like they quit their jobs.

So that's why I would struggle. Strongly support this bill. Thank you.

Thank you, James. Thank you very much. Anyone else wishing to testify on this measure, SB479, if not Members. Questions? Seeing none, move on to the next bill. And, James, I don't know if you're able to stay for the whole hearing, but it's my intention to recommend to the Committee that we move the bill forward. Thank you.

Thank you. Next bill we have is SB 1245 relating to reimbursement of pharmacists. And first up, we have the State Board of Pharmacy. Good morning. Chair James Kazewski here on behalf of. The Board of Pharmacy. Here to stand in our open testimony. In support, I believe. Yeah. Okay. Insurance Division, State of foia.

Good morning, Chair, Vice Chair, Members of the Committee, Jerry Bump, acting Insurance Commissioner. We'll stand on our written testimony offering comments and available for any questions.

Now you're Also suggesting an amendment, not necessarily amendment.

So part of our. An amendment. If the intent of this is to mandate that insurers, insurers recognize pharmacists that are not under contract, then that would require a, you know, in other words, if there's a new mandate, then it would require an Auditor study regarding that mandate.

There was an Auditor study already done on this Bill and they had determined that it's not a mandate. So I think part of our concern or other comment was the way it's currently worded about participating provider and a registered pharmacist could create some confusion on whether or not it applies to providers who are not under contract.

Pharmacists who are not under contract with an insurer. So I think there's just some confusion on our end that could lead to confusion on the.

As I understand the Bill, the intention is to cover pharmacists who are under.

Under contract, then.

Yeah.

Okay, thank you very much.

Great. Thank you.

HMSA morning Chair Takayama, Vice Chair Keokopu Leloy, Members of the Committee Walden on behalf of HMSA just here to stand on our written testimony providing comments on the measure. Thank you.

Okay, thank you. Hawaii Association of Health Plans. Rachel Wilkinson.

Good morning. Chair, Vice Chair, Members of the Committee, Rachel Wilkinson on behalf of the Hawaii Association of Health Plans. We're going to stand our written testimony offering comments.

And we also want to point out that while we support reimbursement of in network pharmacists practicing within their scope, this bill as written lacks clarity on the specific scope of services that the pharmacist would be reimbursed for. Thank you.

Okay, thank you very much. Walgreen Co. Tiffany Ajima, Hawaii Pharmacists Association Corey Sanders.

Good morning. Chair, Vice Chair, Members of the Committee, Corey Sanders, Executive Director of the Hawaii Pharmacists Association. I'm happy to elaborate on the point made by Mr. Bum earlier. This is intended to only cover pharmacists that are already within providers network. I also want to comment on two of the things we've heard today.

So in terms of what services a pharmacist will be able to provide, we referenced Chapter 461, which is a pharmacist scope of practice in the Bill. And one of the amendments I made was to make an additional reference to 461.

I can tell you from seeing this in other states, if we start listing out the scope of services in a payment bill and also reference them in a scope of practice, we're going to be chasing our tails in perpetuity as the scope continues to change. So I would recommend referencing the scope.

And then I also read this morning that there's some confusion about how team based care would work. That's also already within Chapter 461, within a pharmacist scope of practice under a collaborative practice agreement. So just again, continue to reference the scope of practice.

We're also in agreement with some of the amendments that were made from the dhs, including an extended defective date. And I will stand by for any other questions you all have.

Thank you. Thank you. Molokai Drugs Kimberly.

Aloha, Chair, Vice Chair and Members of the House Health Committee Members. My name is Kimberly Svetin. I'm the President of Molokai Drugs, a pharmacy that has been on Molokai since 1935. We are celebrating our nine year in business this year as a rural health care provider.

Access to comprehensive, high quality health care services is our mission at Moloka E Drugs. On behalf of our employees and patients, I am testifying in favor of Senate Bill 1245, draft 2, a bill to mandate reimbursement for not just our pharmacists, but other pharmacists in Hawaii who are part of the network. My testimony does state some examples.

I would also like to add that our pharmacy, since we're the only one on molokai with approximate 7000 full time residents, we do everything that we can to be in every single network in the United States if a patient is on our island. So for example, we had some patients move and retire to Molokai from Wisconsin.

We became part of their network in Wisconsin so we could service these two patients on our island. If you have any questions, I'm going to be here for the whole hearing so I can help answer any questions.

Thank you very much for being here, Dylan Soliday.

Good morning, Chair, Vice Chair, Members of the Committee, my name is Dylan Soliday. I want to thank you for the opportunity to testify in strong support of this bill. I'll stand on my written testimony, but just wanted to share some of my perspective to give additional context.

So I'm a student at the University of Hawaii at Hilo in the Doctor of Pharmacy program. I'm currently in my last year, so I've gone through the full curriculum and I'm in the stage of applying to jobs right now.

So I just want to emphasize that the Doctor of Pharmacy degree is the entry level for practice as a pharmacy or as a pharmacist. And many of us also go on for additional years of postgraduate training in residency or fellowship to practice in specialty areas.

This can include things like pediatrics, advanced diabetes care, oncology, among many others, quite similar to how physicians practice in specialty areas. I just want to say how this bill would help to eliminate barriers to healthcare access in the state and reduce some of the disconnect between the education and the real world practice of pharmacy. The Daniel K.

Inouye College of Pharmacy in Hilo was opened in 2007, and I think this is a great step towards increasing access to health care in the state. But I worry that pharmacists are underutilized right now as we're trained for many services that we don't really offer.

In reality, we're not really taking full advantage of this educational investment, and so allowing pharmacists to build a medical benefit would provide sustainable options for pharmacists to offer these services that we're already trained for, but we currently lack reimbursement.

And finally, I just want to share my concern that if this bill is not passed, I believe we are risking exacerbating the current shortage of health care providers in the state as students and new graduates consider leaving the state to go find jobs on the mainland where such reimbursement pathways already exist.

So I want to thank you again for the opportunity to testify in support of this bill, and I'll be available for any questions if you have any.

Thank you for being here. Let's see, is there anyone else who wishes to testify on SB 1245? Yeah. Please step forward.

Aloha. Aloha Committee for having this. Please introduce yourself. My name is Ilima Decosta. I'm actually here for another measure but hearing the testimony and understanding the issue. As a former provider relations field rep, I understand the needs of the rural community because we are an island community, right?

So various islands, the payers mostly have the benefit of being on the main island where most of the activities are occurring. But there are still people who need services on the neighbor islands and those services are being hindered right now by not being able to reimburse these providers.

In the past under the ACA, HMSA was able to find a way to enable chiropractors and naturopaths to be PCPs in if they wanted to. And I think that this is a natural progression toward that. So I commend you for your studies.

Thank you so much for doing what you do and I want to lend my full support to this measure. Mahalo.

Thank you very much. Anyone else wishing to testify on this measure? If not, members, questions? Seeing none. Let's move on to the next bill which is SB 1279 allowing pharmacists to authorize medications via telehealth under certain circumstances. First up we have the State Board of Pharmacy.

Good morning. Good morning chair and members of the committee. My name is Alana Isobe. I'm the chair of the pharmacy. The State Board of Pharmacy here in Hawaii and the board recently voted to unanimously oppose this bill. So I'm going to stand on my written testimony but I do have a couple comments to highlight.

The purpose of the Board of Pharmacy is to ensure the safety of our patients and the public. To allow telepharmacy or telehealth is in the bill. When an in person pharmacist is on island is not the safest option.

The pilot project mentioned in the bill demonstrated 36 errors in a short period of time which the board had grave concerns. Secondly, our second concern is dispensing controlled substances without direct supervision of a pharmacist. Drug diversion by healthcare workers is a huge issue not only in the state but nationwide.

And our pharmacy technicians right now are not registered or regulated in the state. So to allow unregistered people to dispense controlled substances without direct supervision is dangerous. The board is not mandating or weighing in on any of this 340b reimbursement. The board does not side on reimbursement and the viability of pharmacies and all those things.

As much as we appreciate the neighbor islands and the scarcity of healthcare workers on other islands. That's not the board's purpose. So we did as much as we did comment a lot during our meetings and during the pilot project about 340B. We are not mandating that they work with the pharmacy that's within a mile of their clinic.

We're just saying that we believe that in person pharmacists services are a lot more a lot safer and better for the patient.

It is important to note pharmacists are not currently included under Title 42, Code of Federal Regulations 410.78A thus are not eligible to be covered under this section as it relates to telehealth services through Medicare- through the Medicare program. The board further notes that remote dispensing under certain circumstances as provided in HRS.

461.10.5 was repealed via Act 184 of the 2013 legislative session. The primary purpose of the repeal was to address the location of remote dispensing pharmacies near retail pharmacies which created operational challenges. Without this bill, LCHC does have alternative avenues to fill prescriptions.

Physicians are currently allowed to dispense medications from their clinic and follow their own rules that are not governed by the Board of Pharmacy. So without passing this bill, it's not like they're not going to have medications accessible to the patients of Lanai. Let me see.

Lastly, again, we just want to reemphasize that the board the purpose of the board is for patient safety. And so when we looked at all of the different testimony from Lanai Comprehensive, we did- we did always just put that as the first thing. What is the best thing for the patients of Hawaii Lanai?

And I strongly believe that in person pharmacists is going to be much safer. I'll be available for questions if you have any.

Thank you. State Department of Corrections and Rehabilitation, Tommy Johnson.

Romy Glidewell Department of Corrections Rehabilitation. Standing in for Tommy Johnson. Thank you chair, vice chair, for listening to this bill as a covered entity. Under this bill we plan to utilize the 340B program and this bill allows us to utilize larger companies who don't have to fly over which the state would pay for them to fly over.

To supervise the way that we distribute our medication so it does service our state that way. So we thank you for listing this bill and our intent to support it. Thank you.

Okay, thank you very much. Hawaii Primary Care Association Eric Abe.

Eric Abe for the Hawaii Primary Care Association and strong support of this measure at the outset. I would like to personally thank the chair for Hearing this measure. The HBCA believes that this is one of the most consequential measures this committee will hear this session.

It has huge ramifications on the residents of neighbor islands and rural isolated areas, the economically disadvantaged, Kupuna, the sick and the disabled. You have our written testimony. At its heart, this bill raises two very important parts- policy questions.

Should a single business be able to deny discounted medications to nearly 80% of the residents of Lanai because it reduces their profits? Should an important program like 340b be implemented to make medications affordable and accessible for patients? Or is it better for these benefits to be misappropriated or or disregarded to protect a particular business, profession or interest?

If you believe, like us, that the 340B program should be allowed to work as it was intended, then please support this bill. I'll be happy to answer any questions.

Thank you very much. See on Zoom, I believe you have Aloha Care. Mike Nguyen, not present. Also on Zoom, Rainbow Pharmacy on Lanai. Kurt Schuster, please proceed.

Hi, hold on a second. Hi.

Can you hear me okay? Yes, we can and see you as well.

Oh, thank you. Thank you for allowing me to participate today. My name is Kurt Schuster, owner of Rainbow Pharmacy, Lanai. We've been here 10 years now and happy to serve the entire island, including Lanai Community Health center and Straub Clinic, the tourists, ER, all these, you know, entities we serve.

And we're happy to also participate in the 340b pricing with lanai Community Health Center. If they would like our help, we would be glad to do that with them. I'm not in support of having remote pharmacy when we're two, you know, two blocks away. I think. I don't think that's necessary. Like the board was saying.

The pharmacy board was saying, you know, that's not the intent. You know, if we weren't here. Yeah, I think that would be fine. But since we're down the street as a professional pharmacist servicing the island, I think that we can help everybody here. So, anyway, that's my testimony for today. If you have any questions, let me know.

Thank you very much for participating. Next up, we have Molokai Drugs. Kimberly- Kimberly Svetin.

Did you get my testimony?

Yes.

I was submitting it last night from the airport.

So thank you. On behalf of our employees and patients, I am testifying in opposition to Senate Bill 1279, draft 2, because we want the best care for our residents. We also stand in agreement with the unanimous opposition vote by the Hawaii Board of Pharmacy.

Why do telehealth on the rural islands of Molokai Lanai when there are brick and mortar face to face pharmacists at community pharmacies on each island. On Molokai, Molokai Drugs is less than a quarter of a mile away from the Molokai Community Health Center. Our pharmacy is open six days per week.

Our pharmacists have phone numbers in the telephone book if they need to be contacted after hours. On Lanai, Rainbow Pharmacy is less than two blocks away from the Lanai Community Health Center. Instead of using locally owned small businesses, both Community Health Centers decided to go with a Maui based pharmacy for their patients prescriptions.

If there are no pharmacies on Molokai and Lanai, this measure may make sense. However, you have one pharmacy that has served the island for 90 years on Molokai and another pharmacy on Lanai with an owner who has been a pharmacist for 28 years.

On page five of today's Hawaii Primary Care Association's testimony from Eric Abe, they state that quote, on Molokai there is only one retail pharmacy and they do not participate in the 340B program. Molokai Community Health center is currently working with Lanai Community Health Center's contract pharmacy to develop a similar telepharmacy program that was so successful on Lanai.

Unquote. For the record, we would like to state that Molokai drugs 340b relationship with both the Molokai Community Health center and the Lanai Community Health Center. We were the original 340b pharmacies for both entities. From July 1st, 2006 through September. September 30th, 2019 Molokai Drugs had a contract with Molokai Community health center.

From January 1st, 2013 to February 29th, 2020 we had a 340b contract with the Lanai Community Health Center. Our contract was terminated when the Lanai Community Health center went with the Maui based pharmacy Maui Pharmacy Solutions LLC, also known as Mauiliola Pharmacy.

We have been working with a 340b consultant and trying to garner a 340b contract with the Molokai Community Health center since 2000. On September 4th, 2024 I personally reached out to the very new Molokai Community Health Center's Chief Executive Officer to start conversations.

On January 6th, 2025 the Molokai Community Health Center CEO said that they quote, will not be able to work with Molokai Drugs. The decision is based on financial matters, unquote.

Eight days later on January 14th, 2025 there was an approval on the Federal Government's Health and Services Administration website, hrsa.gov to give Maui Pharmacy Solutions LLC as the Molokai Community Health Center's contract pharmacy, effective on Tuesday, April 1st, 2025.

Molokai Community Health center is hoping this telepharmacy measure that we are discussing today passes so they can use a Maui based pharmacy to service the 7,000 plus residents of Molokai.

For the record, for 13 and a half years, the Molokai Community Health center received positive income every single month from Molokai Drugs for their participation in the 340b discount program.

Thank you for voting against this measure and ensuring that we have in person face to face pharmacists at pharmacies in all of our communities, especially rural ones like Molokai Drugs and Rainbow Pharmacy, in Lanai. 340B entities should be a win, win, win for the patients, the Community Health center and the pharmacy.

I would also like to the Hawaii Board of Pharmacies testimony. They mentioned the 30 something errors that were caught. I would like to add that typically that is not an accurate count. It is more than 36 errors. In our pharmacy, we are, we focus on 100% compliance. 100% no errors. 36 errors is not acceptable.

And if that was our pharmacy, that pharmacist would not be employed at Molokai Drugs. If you have any questions, I will be here for the rest of the hearing. Thank you.

Thank you very much. Let's see, anyone else wishing to testify on this measure, either in person or on Zoom? If not, members, questions?

Question please.

Representative Amato.

Thank you, chair. I have a question for you know, let's go with Molokai Drugs, please.

Oh, can you. She's going to ask you a question.

Okay. I'm sorry.

Thank you. Thank you for being here. I know coming over from Molokai is not easy.

Yes.

Is there ever an occasion when Molokai Drugs, or even Rainbow Pharmacy for that matter, does not have a prescription in stock that a patient has been prescribed? If so, how often does that happen. And how long on average does it. Take to get that prescription?

So I'll answer it for Molokai Drugs, we have an inventory system. We do inventory every single day. It's a virtual inventory. Our warehouse is on Sand Island Road. If we get the order by 6 o' clock, we get the prescription drugs at our doorstep before we open.

We also have a SYNC program where we manage over 1,000 people and we especially our kupuna, because a lot of my neighbors have kids that don't live on Molokai. We call ahead and say, auntie, just letting you know we're working on your prescriptions. You know, one of them, the refill is due, you need to call your doctor.

We are managing our patients, over a thousand of them. And on top of that, we also do blister packs and packaging for free for our patients that are. If a doctor requests that this patient who doesn't have a caregiver or family, we will do blister packs gratis for our patients.

I also have to answer your questions very rarely. And if that does happen, we will try to. So for example, if it's a 30 count pill bottle and we only have 15 in stock, we will give the 15 in stock. I have a system of laminated cards that says IOU second fill.

So that means the next day we will give the patient the rest of the prescription so they won't do without. But we try to prevent that by managing our patients. I also have eight people on my car insurance policy, so every so often. We had a situation last month where one of our patients, his car broke down.

He has no family on the island. He lives 19 miles from our pharmacy. And one of our employees at the end of his shift drove out 19 miles at 6 o' clock to drop off his medicine. I will tell you, mail order will not do that. We are the way we are.

My sister and I moved back from the mainland to continue this. My dad was the second pharmacist of this pharmacy. And a couple weeks ago he says, hey, Kim, you think he can stay for 10 more years so we can hit 100 years? And I said, no, I cannot promise you that because I'm not.

If we lose money and we are in the red, I'm not going to keep the business open.

Thank you. Thank you, chair.

Okay, thank you. Members, any other questions? If not, I do have a question for the Hawaii Primary Care Association. Mr. Abe, I'm interested in hearing. I mean, you heard the testimony from the Board of Pharmacy opposing the bill and raising safety concerns. What are your thoughts on that?

You know, it's really unfortunate that Lanai Community Health center was not here to actually testify. They actually had wanted to testify today, but because they are currently involved in litigation with the Board of Pharmacy over the implementation of this program that they decided it would be best for them to actually sit out of this hearing.

But basically, when the telepharmacy project was allowed to expire, the Board of Pharmacy did not provide Lanai Community Health center with an opportunity to state reasons to try to keep the program going. And so the program was effectively stopped on June 1st of 2024 because Lanai Community Health center is the only 340b provider on that island.

The only way that they could continue to provide discounted medications on that island was that they had to fly in a pharmacist from Maui in order to actually dispense the medications at their Lanai Community Health center site. And they've been doing that. They've been doing that all until this bill was actually introduced.

And two days after it was heard, the Board of Pharmacy, without any prior notice, basically sent a communication to Lanai Community Health center telling them to stop their pharmacy operations on that on the island. And so because of that, Lanai Community Health center had to file an injunction to allow them to continue to operate.

They filed it on March 7th, I believe, and it's my understanding that the court, the judge did order a temporary restraining order to allow them to continue to operate. And it's still pending further review to see whether or not the assertions that they made are valid as far as whether or not they can stop those their actions.

Regarding the errors that they mentioned, you know, it should be pointed out that I don't know how many they said 36- 36 or whatnot. Should be noted that during that same time frame, they filled over 5,000 prescriptions during that time. And they did note, too, that many of those discrepancies or errors were.

They were basically administrative, many of which were they didn't press the right button or I don't know the specifics. But as I recall, they had a valid justification for those occurring.

As far as I know, there was never a complaint that was filed against Lanai Community Health center during the time that they were operating the telepharmacy project, nor at any time that they were actually operating pharmacy operations by flying in a pharmacist do this.

It should be noted they've been doing this at great cost because they felt very strongly that if they didn't do this, 80% of the patients on Lanai would not have access to discounted medications.

So ultimately, the policy question before this committee is are we going to actually support 340b or, you know, are we just going to move on and let businesses do what they want?

Thank you. Any other questions? If not, let's move on. Next bill is SB 1323 relating to uniform healthcare decisions.

Hawaii State Department of Health, ALA Chair, Vice Chair, Members of the Committee Kevin Camisado Department of Health Development Health Division. We're here to stand our written testimony, we're available for questions. We do support the updating of the legislative hrs to reflect the Uniform Health Care Decisions act of 2023. Thank you. Thank you very much.

Let's see on Zoom, I believe we have the Hawaii Disability Rights Center. Louis. Yes, go ahead. Please proceed.

Yes, thank you. Good morning. I think I'm trying to turn the video on if you like, but. Okay, well, we can hear you and now we can see you. Okay, thanks. Thank you. Chair, Good morning.

We continue to oppose this so called Ulysses clause, where somebody can enter into an advanced directive and basically say that even if they change their mind, it's okay to be involuntarily medicated.

When this measure was heard in the Senate, the Senate Chair and the Attorney General said, well, it's already in the current law, so you know what, you know, what's your issue.

But then I look closer and I spoke to the Attorney General and the Attorney General's written testimony for this hearing seems to agree that the current law is not clear. The current law just says that people could enter into a directive and consent to various medication.

The Ulysses clause says that even if the person changes their mind, they can be involuntarily medicated. So the way that normally occurs is through a judicial process. And so if the person meets the criteria for involuntary medication, then so be it. If they don't, then it doesn't happen.

But what this would do is basically sort of wave a piece of paper in front of somebody and say, you already said that it's okay to involuntarily medicate you, and so they can then hold them down and forcibly medicate them. I don't think it's good policy.

I'm not convinced it would, it would hold up in court and I couldn't imagine why a medical person would want, would want to take that chance and not pursue a court proceeding. So I'm told this is somewhat controversial around the country. So I would urge caution to the Legislature.

And if for some reason the Legislature wants to allow this, I think the law and any forms ought to be very clearly framed so that the person fully understands that they're waiving some serious legal and constitutional rights. So thank you very much, Chair.

Thank you very much. Peter Hamasaki, Commission to Promote Uniform Legislation on Zoom.

Hi, good morning. Thank you, Chair. The Commission will stand on a truth and testimony in support of this measure. Thank you.

Okay, thank you. Anyone else wishing to testify on SB 1323, if not Members? Any questions? Okay. Seeing none. Let's move on. SB 1411, relating to Medicaid third party liabilities. Department of Human Services.

Hello, Chair. Members of the Committee, on behalf of. The Department of Human Services, we stand. On our written testimony and strong support. Thank you.

Thank you. Let's see, that's all the testimony I think we have on SB 1411. Anyone else I missed, if not Members? Any questions? Seeing none. Let's go on to the next bill, which is SB 1452 relating to uniform Control Substances Act. And we have Department of Law Enforcement.

Hi, Chair. Vice Chair. Members of the Committee, Brandon Asuka, Department of Law Enforcement, will stand on our testimony and support.

Thank you. Support. Because this is your bill, I believe. Yeah. Okay. All right, let's see anyone else who can testify on this bill. If not, let's move on to SB850, relating to a proposed study on health disparities among the disabled community, starting with Hawaii State Council on Developmental Disabilities.

Aloha, Chair, Committee Members. My name is Chase Silvert. I'm here for the Hawaii State Council on Developmental Disabilities on behalf of Daintree Bartholdis. We're going to stand in our written testimony in support. We just wanted to highlight a few things, which is that this study is really.

Because for our IDD community, we don't have this kind of information in Hawaii. We have a lot of mainland data and we can kind of try to use it so we know there's problems. We know we have barriers. We know that these barriers cause ER visits, hospital visits and things like this. Because they go untreated.

As of today, nobody has this data in Hawaii, so I could not tell you these things for a fact. This is the whole point of the study, and it can help maybe reduce these ER visits and get our quality of life for IDD community just to be better. Thank you so much.

While you're up there and before you step down, your testimony doesn't contain an estimated amount of money that would be needed for such a study. Do you have an estimate?

Yes, it's $500,000 to $600,000 for a two to four year study.

$550,000 is what I think I heard you say.

Yes, $550,000 would work.

All right, thank you. Thank you. Next up, we have Hawaii Disability Rights Center.

Yes, we're in support, Chair. In particular, I would highlight that there's a finding that the DD Medicaid waiver is not serving nearly as many people as they should. And so I'm hoping that one of the results of this study will be to identify particular gaps in the DD waiver system. Thank you.

Thank you very much. James. Library. James, would you like to move up to the table in strong support? Okay. Thank you very much. Anyone else I missed who wishes to testify on SB850? Seeing none. Members, Questions? I don't have any either. So let's move on to the next bill, which is SB 1438 relating to home care agencies.

Department of Health.

Good morning. Thank you. Chair, Vice Chair, Members of the Committee, I'm Justin Lam, representing the Department of Health on this measure. The Department stands on its written testimony in support of this Bill. Over the past eight years, home care agencies have been utilizing unlicensed personnel to perform skilled nursing services, putting our kupuna at risk across the state.

So thank you again for the opportunity to testify. And I'm available for any questions.

Might stay up there since you're the only testifier, I believe, on this Bill. But I'm interested in knowing what kind of services that are unapproved, that being, were being provided in your investigation.

So in, in our daily inspections or, you know, we inspect these facilities for licensure. Sorry, the agencies for licensure, we're finding that personal care aides and homemakers are providing skilled nursing services like catheter care, Foley changes, wound care, medication administration, you know, other. Other things like that, even wound vacs and things of that nature.

So those should be done by a CNA under, you know, chapter 457 under nurses, and then using nurse delegation for CNAs to be doing those services under private duty nursing and not home care agencies.

So under the current situation, what do you do when you encounter such cases?

We issue deficiencies, but the rules aren't very clear, and we don't have it in statute to have ability to do enforcement against these agencies right now. So right now we're just citing what we can. But, yeah.

All right, thank you very much. Any other questions from Members? If not, thank you. I'm sorry. Did you want to testify?

Yes.

Please step forward. No, you don't have to apologize. Please step to the mic.

Ilima DeCosta, again, I think the reason why I want to testify is because I've had an opportunity to assist some of the care homes, and the biggest problem we have is a lack of care homes that are available to provide services to individuals who are covered by Medicaid.

Medicaid has such a low rate of reimbursement that these care homes are struggling, sir. So I've had to, in my capacity as a social worker for the State of Hawaii. I've actually gone out and delivered food for the care homes because we found.

Ilima, could you address the Committee?

We found that I had to deliver food to the care homes because we found that individuals were not being fed enough because they're schizophrenic and they have particular desires for their, their own personal diet.

So I think that what it is that we're dealing with is we're dealing with staff who, like the schools that are being proposed to administer medications later on in this hearing, want to be able to provide more services because there are gaps in what Medicare will reimburse and what they can afford in these homes.

So I hope that you will consider being a little bit not lenient, but providing more support and services to these care homes because I think that that's what we really want to go to. Rather than being punitive, I think we really want to be able to those care homes and give them the additional services that they need.

So mahalo for that.

Thank you. Anyone else wishing to testify? Members, any other questions? If not, let's move on to SB228 relating to excited delirium.

Department of Health, good morning, Chair, Vice. Chair, Members of the Committee, I'm Wanda Naonishi with the Department of Health. We stand on our written testimony offering comments. I would like to point out a typo in our testimony.

We recommend amendments to Chapter 327C, Hawaii Revised Statutes, as stated later on in the testimony, and not to Chapter 326, which is the typo in the first part of our testimony. So thank you for this opportunity to testify.

Oh, I see. Okay, got it. All right. Thank you. Hawaii Disability Rights Center.

Yes, thank you. Thank you. Good morning, Chair. We, we had a lot of discussion in the House already on this, so I'm not sure I need to go into it too much. When you passed House Bill 36 and the House Judiciary Committee passed House Bill 36, I think you folks, I think you folks got it right.

While I do appreciate where the Senate is coming from, I think the main difference is that the Senate Bill really doesn't accomplish all that much. It still allows excited delirium to be offered into evidence as a defense. And with all respect to the judiciary, I just think that that's going to lead to potentially inconsistent results.

I think it's pretty clear that this has been debunked just about everywhere. And so I don't think leaving it saying, well, let's let the judges decide. I think in some cases a judge is going to Say, okay, maybe allow it. And in some cases they won't allow. I think a blanket rule makes a lot more sense.

I know that Julia Sherwin is here this morning, and she can elaborate in more detail. But basically, I would just urge you to reinsert the contents of House Bill 36 into this measure and. And then further discussion and conference can always occur. So thank you.

Thank you. Cat Brady, Community alliance on Prisons Present. Okay. Julia Sherwin. Hadid and Sherwin.

Good morning, Chair, Vice Chair and Committee, mahalo for allowing me to speak with you today. My name is Julia Sherwin. I've been a civil rights lawyer for 30 years, and I have been dealing with the junk science defense of excited delirium for two decades.

I co authored the Physicians for Human Rights report on excited delirium, which I referenced in my written testimony. Thank you, Chair Takayama, for having introduced HB36 on excited delirium and shepherding that through your House of Representatives.

I'll note that it passed the House floor with zero no votes and also with no opposition from the law enforcement community nor from the medical community. Unfortunately, that bill has died in the Senate because it was not scheduled for a Committee hearing. SB228 has three omissions that are very key that are not in HB36.

And amending SB228 to match the language of HB36 would cure all three of those emissions. The first one is that SB228 removed the alternate names for excited delirium that have been used by proponents of the theory for decades, including agitated delirium, hyperactive delirium, and exhaustive mania.

So if SB228 were passed as it is, it would still allow the proponents of excited delirium to just change the name to agitated or hyperactive delirium and keep using the term.

The second flaw or omission in SB228 is that it only prohibits public health or Department of Health employees from documenting or testifying that a person was an excited delirium. And that leaves all other employees or contractors of any public entity here in Hawaii free to continue using the theory.

And then the third very serious omission is that SB228 has removed the prohibition on admitting into evidence and civil actions evidence about excited delirium. That Prohibition is in HB36 or was in HB36 until it died.

And that's very important because there is a cottage industry of defense experts who make a lot of money promoting excited delirium in civil cases. Even when excited delirium has not appeared as a cause of death in an autopsy report or a death certificate. That's exactly what happened in the Sheldon Halleck case.

As I referenced in my written testimony. Excited delirium was not a cause of death for Sheldon Halack in his autopsy or in his death certificate.

But the defendants in his Ohana's case hired three defense experts with very strong ties to Taser International, including the a Taser board Member who served on their board for 20 years until last year to testify that Sheldon died of excited delirium and his family and he were denied justice in their case.

This is the 10th anniversary, actually, of Sheldon's death, was two days ago. I ask you to please amend SB228 to include the language of HB36, which would completely cure the deficiencies in the statute. It would honor Sheldon and his Ohana and send a message that his death was not in vain.

And it would protect the people of Hawaii from this junk science, as the people from my state in California have now been protected. I'm happy to answer any questions. Mahalo for your time.

Thank you very much. Elima DaCosta Hui Malama Pono, Hawaii.

Aloha. Elima DaCosta, testifying in support of SB228. As the prior testifiers have indicated, I am concerned about the lack of the reference to the evidence. I do want to make sure that rules of evidence do not allow the judiciary to be able to have that much discretion.

And it does appear as if the judiciary does want to maintain that discretion.

I'm also concerned, and I'm glad that we're going to be having this pilot project that's going to be sponsored by the state because with regard to individuals with disability rights and other types of developmental issues, because I think that it's about time that we started to have some parity within our health care system for individuals who are suffering from any kind of behavioral health and developmental kind of issues.

So I'm in strong support of SB228, but I would like the language to be cured. And I think that it's not reasonable for anybody to cross the street and end up dead just as a result of jaywalking. So I want to acknowledge that two days ago was the 10th anniversary of Sheldon's passing.

And as a mother who also lost a child to preventable violence, I really do hope that we can improve and be a better community. So mahalo to everyone. Mahalo to the chair and the Committee.

WI Kim.

Good morning, Chair. Vice Chair Members of the Committee. My name is Wookie Kim. I'm with the ACL of Hawaii, and we support SB228 with certain amendments. And, you know, I think Mr. Ertic and Ms. Sherwin have adequately explained why the current bill, in current form is really deficient.

And I want to focus primarily on the evidentiary component, because without that, this Bill doesn't really make that much of a difference. Because as others have noted in Mr. Halleck's case, the medical examiner did not diagnose excited delirium. It only came up at trial.

And so it is really, really important that this Committee reinsert the evidentiary component to the bill. The other point I wanted to make, too, is that under the current model, you know, the judiciary makes some comments about how the existing rules already protect against abuse. But that didn't work for Mr.

Halleck in his case because the rules governing expert testimony and unduly prejudicial evidence were relied on by Mr. Halleck's counsel, and the court nevertheless admitted the testimony. So it's really important to include it. I wanted to reassure the Legislature that there is ample precedent. Right. For the Legislature passing rules that exclude certain subject matter from evidence. Right.

And I would actually point to Ms. Sherwin's testimony, which written testimony, which includes a lot of examples. But just as a recent example, in 2019, HB 711, which was passed as Act 149, prohibits criminal defendants from asserting what is colloquially known as a gay or Trans panic defense. And that's just one.

One recent example where, you know, because of concern about the undue prejudice from invoking certain testimony, this Legislature decided it's not permissible for people to testify to those. To that subject matter.

And the final point I wanted to make is just responding to what the judiciary noted in their written testimony, which is that there is, quote, no definitive consensus about excited delirium.

But I think all of the testimony, if you look at it and if you look at the supporting citations and documentation, there is a definitive consensus, at least at the moment.

Every single major medical and scientific body, including the World Health Organization, the American Medical Association, all of the relevant medical examiner groups, including the ones that formerly stood by excited delirium, they have all stepped back from rejected, denounced, excited delirium. So there's no. The consensus is strongly against it right now.

And if there's concern that that consensus changes in the future, the Legislature always has the ability to amend the law as the science develops. But as things stand today, this is junk science. And for that reason.

And given all the injustice that was inflicted upon the Halleck family and many others, it's really important that that evidentiary component be reinserted, as well as the other amendments that Ms. Sherwin noted, which are also included on the last two pages of our written testimony. Thank you.

Thank you. On Zoom, I believe we have Verdell Halleck. Please proceed.

Good morning, Chair, Vice Chair, and Members of the Committee. My name is Verdell Haleck, and I strongly support SB228, SD1 relating to excited delirium.

And I ask if SB 228 can be amended to insert the important language that was deleted from this Bill to make it exactly like HB36, HD2, so that it can protect the other Hawaii families from suffering the same tragic situation like ours.

I am speaking for my son, Sheldon Halleck, who was a loving husband, father, son, and he was honorably discharged from the Hawaii Air National Guard, suffering from his past deployments with PTSD, drugs and other mental health issues.

On March 17, 2025, it marked 10 years since Sheldon died from an encounter with the Honolulu Police in front of Iolani Palace for jaywalking. He was unarmed, not aggressive, and he was having a mental health crisis.

He was pepper sprayed 12 times, tased three times, and handcuffed and hogtied with police officers on his back and one with a knee to his neck where he became unresponsive and died. The police claimed he died from excited delirium.

We filed a civil lawsuit against the officers involved, and the defense expert said Sheldon didn't die from being pepper sprayed or from being tased or from the excessive use of force by the police, but he died from excited delirium.

The jurors believed that it was a real medical diagnosis and found the police officers not responsible for Sheldon's death. In 2023, the American College of Emergency Physicians disavowed their white paper, which was the backing for excited delirium being used as a medical diagnosis.

This injustice is what spurred our request for change in the introduction of Senate Bill 228 SD1 relating to excited delirium. Several states have recently passed bills to ban excited delirium, and Hawaii should follow their lead. Our goal is not only for Sheldon, but for all those who unjustly lost their lives while in police custody.

Thank you for your time, and I ask for your support for Senate Bill 228 SD1 relating to excited delirium. And I humbly also ask if this Bill can be amended to be like HB36 HD2. I ask also humbly, if this Bill does get passed, if it could be called Sheldon's Law or Act in honor of my son so his death was not in vain. Thank you.

Thank you very much, Mrs. Haleck. Taryn Tomasa.

Good morning, Vice Chair, Sonny Ganaden, Deputy Public Defender. On behalf of my colleague, the head of The Appellate Division, Ms. Taryn Tomasa, we are in support of this measure. We're just going to reiterate the changes that the ACLU and Mr. Erteschick suggested.

It's going to be public defenders that are most likely having to argue this when it goes up before appeals and, and before the trial courts. We respectfully disagree with the judiciary's testimony that this should be decided in evidence by a judge.

We think that at that point it's already too late, that because it's junk science, because it had been proven to be essentially prejudicial, we believe that it should not even be admitted into court. I currently represent individuals with schizoaffective disorder and individuals who have Bipolar type 1 disorder.

They could be described to have many of the symptoms of what is now called excited delirium. We have a mental health crisis in on all islands and throughout our community. You know, if an individual is threatening or acting aggressively, police officer can just put that in the report. And that is a valid use reason to use force.

Any other reason is illegally invalid. Thank you.

Thank you. Second call for Community Alliance on Prisons.

Good morning. Kat Brady testifying in strong support of this measure. We actually request that you insert the language from HB36, which is more clear. And I think that's really, really important. So we know that medical groups across the continent and the world have actually looked at this and said, what is this?

And after doing lots of research, they Found out that they reject this. This is not science and police officers are not doctors. So how could they even describe something that doesn't really exist? So thank you so much and I hope you can insert the language for HB36. That would be really helpful. Thank you.

Thank you. Anyone else wishing to testify on SB 228? Seeing none. Members, questions? I know we've considered this bill before. If not, let's move on. SB 299, loan repayment and Department of Health not present, but in support. Dr. Jack Lewin, Hawaii State Health Planning and Development.

Good morning, chair, vice chair and members. We're very strongly in support of this. This measure is the strongest, strongest influence we have to bring new doctors here, new nurses here, new professionals of all the whole spectrum. It's working. We need to keep funding it because our workforce shortages is actually progressing in the wrong direction.

This is really working. Thank you for your support.

Thank you. University of Hawaii, Kelly Whitby. Oh, there you are.

Good morning. Chair, vice chair, members of the committee. Kelly. Whitby the University of Hawaii, I administer this program and it's helped 800 people pay down their loans so far, Hawaii residents, about 100 of them are either residents who are coming back to Hawaii or going to stay in Hawaii or new folks to Hawaii in all healthcare fields.

So we would hope that you continue this. Our current contracts are for two year commitment. I know it's a blank in your document. If you want us to change it, we can change it going forward, but not backwards.

And I just want to say make sure you stay well hydrated because you're working very hard and you know, we don't have enough health care providers. Thank you. Oh, strong support.

Thank you. Hawaiian Association of Health Plans. Rachel Wilkinson in support. Okay, thank you. Aloha Care. Mike Nguyen not present. Anyone else, I missed wishing to testify on SB 299?

Okay.

Yes. Please step forward. HMSA. HMSA supports. Okay. Anyone else? Okay. If not, this is another bill we heard previously and, well, let's move on. Oh, I'm sorry, Chair Marten.

I just wanted to know what kind of wait list or what kind of demand is there? Like how many. I know you served 800. How many people have applied and how do you choose who gets it?

So we had 2,600 applicants from all fields of healthcare. Our priority is primary care, mental health and rural areas. So right now we're only going through. And we haven't gotten all of them.

The primary care providers, the mental health providers of all types, and then any doctors, nurses or, sorry, doctors, nurse practitioners or physician assistants on neighboring islands or Waianae, Waimanalo, North Shore. We have only gotten through one quarter of our list.

So if you had extra money, which I know won't happen, we could use it to give to your constituents because there are 1600 people waiting.

Okay, thank you, Representative Lee Loy.

Thanks for staying there. You're right, the year is blank. I was just really curious. In the past, it was a two year program. Of those going through the program, how many have stayed? And I'm just curious, if we made it a four year program, would more stay put?

Well, we're not quite done with the first two years yet. So everybody's still here. Nobody's left. And then. So September 1st is when the first program started. So on September 1st this year, I can tell you if anybody's left. Nobody has indicated and that they're leaving. And people have asked me, will we get more money?

And right now I have to say I don't know.

Okay, great, thanks.

Okay, thank you. Any other questions? If not, let's move on to SB 1612. Fitness to Proceed. Office of the Public Defender.

Good morning. Again, Chairs, Vice Chairs Sonny Ganaden, Deputy Public Defender we're in support of the intent of this Bill. However, we believe that it's violative of the Brown vs Plata decision which mandates that individual with mental health treatment concerns HRS 704 designations are legally differentiated from the rest of the pre trial population.

We understand that this comes from lack of mental health facilities statewide, but especially on Hawaii island. Here on Oahu individuals with these kinds of mental health issues can go to Hawaii State Hospital, Queen's Kekela, right across the street, Castle or the one on the windward side. Sorry, it's escaping me.

We believe that this would codify an illegal practice and open the state to liability. For that reason we are unfortunately testifying in opposition.

Okay, thank you. Department of Health.

Aloha Chair, Co Chair and Members of the Committee. My name is Terrance Cheung. I am the Chief Strategy Officer at the Hawaii State Hospital, Department of Health. The Department stands on its written testimony supporting the intent.

With concerns regarding the operationalizing of the pilot program in Senate Bill 1612. We believe that jail based competency restoration programs have been proven successful. The Department appreciates the Legislature's efforts to safely reduce the state hospital census.

Our concerns are about costs as the Department of Health would require additional funds to provide these services and we defer to the Department of Corrections and Rehabilitation on the funds and the location they would need to create the proper environment to deliver these services. Thank you very much.

Thank you. Department of Corrections and Rehabilitation.

Aloha Chair, Vice Chair. Romey Glidewell, Corrections Healthcare Division Administrator in for Tommy Johnson who's in the cabinet meeting. He apologizes and will be here shortly, hopefully. But we do offer our written testimony with support with intent.

We have outlined, given the current amendment, we have outlined what it would take for us to accommodate the intent of this Bill. And we're here if you have any questions.

Thank you. Louis Erteschik, Hawaii Disability Rights Center on zoom.

Yes, thank you, Chair. Our issue is the Clark injunction because our office brought that case about 20 years ago. And so Clark and I think we've discussed this previously that. So Clark requires that once somebody is found unfit to proceed, they be transferred to the custody of the health director within 72 hours.

Typically that means the state hospital. This version is definitely better than the prior one. When this was heard at the, at the last Committee there was still language in there about the person would be either in the joint custody of the, of Public Safety and the Health Department.

And so the word joint custody led to a lot of concerns that somehow that could be considered to be complying with Clark. The Committee did take that out, and so it just says that the Health Department will partner.

So to that extent, this version, on its face, doesn't seem to violate the Clark case, from what I can see. I think that. I can see how a Clark violation could potentially creep back in, whether it's in conference on this measure or depending on what happens down the road.

But at this point, I would simply say that I think the last Committee did a good job trying to get, trying to solve that problem. So thank you.

Thank you. Hawaii Psychological Association on zoom.

Aloha. Good morning, Chair, Vice Chair, Committee Members. My name is Alex Lichton, I'm the Legislative Chair for the Hawaii Psychological Association, and I'm very familiar with the Fitness to Proceed process. As a forensic psychologist, I've done about 1500 fitness exams over the last 17 years. I think, at minimum, the Attorney General could be, should be consulted.

I don't know that the Clark violation problem has been solved as long as somebody's been found unfit and the treatment is in a jail setting. On the surface, it would appear to violate Judge Esdra's decision in 2003 in U.S district 4.

In which he held that a person should be transferred to the State Hospital within 72 hours of being found unfit to proceed because treatment in the jail setting is a violation of constitutional rights.

And I was well aware in 2004, when I was the forensic coordinator at the state hospital, that the state was paying out fines of $1 million at that time for Clark violations. This legislation appears to be in reaction to the state hospital being overcrowded. But of course, our jails are also severely overcrowded.

And I don't think there's a legislative fix to the overcrowding at the state hospital, which is caused by cutbacks in outpatient services, particularly outreach, lack of civil commitment, psychiatric hospital beds in the community, cutbacks in psychosocial rehabilitation funding, which has led to poorer outcomes with increased recidivism and lack of jail diversion.

Currently, about 40% of the jail population has a severe mental illness, and I fear that if this Bill is passed, that percentage would be even higher. So I think you can avoid potential costly lawsuits and fines by deferring SB1612. Thank you very much.

Thank you. Let's see. That's all the testifiers I have on this measure. Anyone I missed? Please step forward.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, Committee Members. Carrie Ann Shirota, Policy Director, on behalf of the ACLU, Hawaii. I apologize. I thought I submitted the testimony. It's in my computer. I didn't send it, but I will. We strongly oppose this measure. I think several of our colleagues have mentioned the constitutional violations of the Clark decision.

We are not convinced that this Bill, despite some of the changes, that there's still potentially a contravention of that decision where Judge Esdra decided and ordered that once a person is found unfit that the state is required to transfer them to the Hawaii State Hospital within 72 hours.

And not only is that decision the law of the land, but the Department of Corrections passed a policy in 2024 codifying the Clark decision. And it mimics the Clark decision, which also states that the Department is required by their own policies to transfer someone to the Hawaii State Hospital within 72 hours.

Beyond the Clark decision, we are troubled by the potential investment in appropriation at a time when we are facing significant budget cuts, possibly a recession and even special session to deal with the budget for an untested, unproven pilot project. We need to look at what's existing.

Simply put, jails are the worst place for a person with severe mental illness. We've heard here that the Hawaii State Hospital is overcrowded as well as our jail. But let's look at the data provided by Dr. Luke. Last year in an informational briefing, only 23% of the patients at the Hawaii State Hospital were admitted for clinical reasons.

38% were at the hospital committed to a lack of transitional housing. If you add that up, that means that 71% of the people there do not need to be there. And that is at a cost of $1,000 per day. Having someone incarcerated is $310 a day, over $100,000 a year. So both are expensive.

So what we should be investing in is community based services, providing for community based competency programs, diversion, that's where the need is. That will not only be more cost effective, but that will truly help the people who are most vulnerable in our community.

So we ask that you hold this measure for both constitutional as well as practical reasons. Thank you.

Thank you. Let's see. Anyone else wishing to testify on this Bill, on Zoom or in person? Seeing none Members, any questions? I do have a quick question for Department of Corrections. I mean, yeah, Corrections and Rehabilitation. I, The Psychological Association said that. I'm interested in whether it's accurate.

Mentioned that 40% of your jail detainees suffer from severe mental illness. Is that right?

Yeah. That may actually be low.

Maybe low?

Yeah.

Okay. Okay.

Thank you very much. All right. Thank you. There being no other questions, let's move on to the final bill on the agenda, which is SB 532, which allows trained volunteers to administer medication in schools. And first up, we have the Department of Education.

Good afternoon, chair, vice chair.

In support. Okay. University of Hawai'i System.

Good morning. Chair Takayama, Vice Chair Keoho Kapu Lee Loy and members of the committee. My name is Clementina Sergi Ulep, Dean of the University of Hawaii at Manoa School of Nursing and Dental Hygiene. The University of Hawaii School of Nursing and Dental Hygiene and John Abrams School of Medicine are in strong support of this measure.

Thank you for the opportunity to provide testimony.

Thank you. Let's see. Department of Health.

Aloha chair, vice chair and members of the committee. My name is Cherry Edrosa of the Public Health Nursing Branch representing the Department of Health.

We stand on our written testimony in support of this bill that improves the ability for children with health conditions requiring medications to receive their pre approved medications at school, allowing them to attend school and off campus enrichment activities. I'm available for questions. Thank you.

Thank you. Terry Armbruster not present. Oh, yes, sorry. I'm sorry, was that you? Oh, okay. You testified. Okay, let's see. On Zoom, I believe we have Nicole Munoz. Munoz, Nicole.

Hi. Aloha chair, vice chair and members of the committee. My name is Nicole Munoz. I am a parent of student attending a DOE public school and I stand on my written testimony in opposition of this measure. Mahalo for this opportunity.

Okay, thank you very much. Let's see, that's all the testifiers we have on. On my list on SB 532. Did I miss anyone on Zoom or in person? Good.

I am testifying in opposition of this bill and the reason why is for the exact reason why the Board of Pharmacy testified in opposition to telehealth. Their testimony was that there was not direct supervision of these pharmacists or of the administration.

And I think in this situation it's of kind, kind of runs along the same lines. There's not direct supervision and it even proposes that volunteers would do this administration of medications.

I'm not saying that parents shouldn't be allowed to make some decisions, but it sounds to me like there's something else going on and they want to facilitate the administration of medications that maybe parents don't necessarily want to be administered.

So respectfully, I'm opposed because I think that it should be administered by certified or licensed individuals, not just by, by trained individuals. Mahalo.

Thank you anyone else I missed wishing to find this bill? If not, members questions? Chair Marten.

I wanted to ask you to respond to the assertions that somehow this would be forcing medication on children that was not prescribed by their healthcare providers.

Right. So- So it would be the bill does state the medication must be prescribed by a licensed provider, the parent must give permission to have someone administer the medication. And the medication can only be administered as directed by the healthcare provider.

Thank you. Any other questions? If not University of Hawaii Dean Ceria-Ulep, I have a question. What kind of training would be provided to volunteers prior to them being eligible to provide medication?

Okay, thank you for your question. And I'll start then. I'll have Ben Kalinsky from the Department of Education to also provide additional comments as they will be launching the program and training as well.

Would he be in a better position to answer the question?

Yeah, I can start. But in terms of the training, they'll be trained on the way it should be administered by mouth or through the nasal or intradermal intramuscular. So those type of training would occur. But please add some more then go ahead.

I'm Ben Kalinsky. I'm a pediatric nurse practitioner with the Hawaii Keiki Program and serve as a clinical consultant to the Department of Education.

So answering in the context of the department's protocols for training, there are standards that are established for medication administration for school health assistance which have been in the state and a core to our school health program since 1970.

So we continue to work with the Department of Health as far as how that training and oversight to how that is delivered.

And the bill would allow other individuals that are already employees of the school to be trained in the same procedures with the same narrow scope of what medications are approved by a nurse to be administered by a person with that training.

And what maybe hasn't been addressed in some of these discussions previously is that the Department of Education is using nurses to administer any medication that is necessary for a student which is not deemed appropriate for a minimally trained person.

So again, this is very narrow scope of what's allowed relative to the training and the oversight that a nurse can provide to that person.

Okay. Thank you very much. There being no other questions, I think we can move on to decision making and we'll begin. First of all, hold on one second, members. Okay, thank you all for being here.

For being here, and let's see, the first bill on our agenda was actually heard in Joint Committee, Health and Human Services and Homelessness, and it's SB 1442, relating to mental health services for children and adolescents. I'd like to move this forward as a House Draft with a--adding a new defective date as well as technical amendments for clarity, consistency, and style. Any questions? Concerns? Seeing none, I believe we can take a vote. Vice chair.

Members, voting on SB 1442 Senate Draft 2. Chair's recommendation is to pass with amendments. Chair votes aye. Vice chair votes aye. [Roll Call]. Chair, your recommendation is adopted.

Same recommendation for the Committee on Human Services and Homelessness. Any questions or comments? Seeing none, vice chair for the vote.

Voting on SB 1442 SD 2, chair's recommendation is to pass with amendments. Chair and vice chair vote aye. [Roll Call]. Chair, your recommendation is adopted.

Thank you very much. Moving to the 9:05 a.m. agenda, Committee on Health. First bill we had was--excuse me--SB 479, relating to the Hawaii ABLE Savings Program, which in chair's view is a much-needed program and very much welcome in our disabled community as far as I'm concerned.

So I'd like to propose that we move this forward as is with committee report language suggesting that if the Committee on Finance should so consider this measure that it consider providing $75,000 as well as one FTE employee to administer the program. Members, any questions or comments? Thank you. Vice chair for the vote.

Thank you, chair. Members, voting on SB 479 Senate Draft 1. Chair's recommendation is to pass as is. Chair votes aye. Vice chair votes aye. [Roll Call]. Thank you, members. Chair, your recommendation is adopted.

Thank you. On SB 1245, it's a measure which recognizes pharmacists as professional healthcare providers for reimbursement purposes. I would like to move this forward as a House Draft with technical amendments as well as another amendment to change the chapter from 432d-23 to 432d for clarification purposes. Members, any questions or comments or concerns? If not, vice chair for the vote.

Thank you, chair. Members, voting on Senate Bill 1245 Senate Draft 2. 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. The next bill is SB 1279, enabling pharmacy services to be offered via telehealth under certain circumstances. You know we use telehealth for other medical and health services.

So I'd like to move this forward with a new defective date and also in our report language, encourage community health centers to engage as much as possible with area pharmacies utilizing the 340B program to enable to the fullest extent possible to offer in-person pharmacy services. So that's my recommendation. Members, any questions, comments, or concerns? If not, vice chair.

Thank you, chair. Members, on SB 1279 Senate Draft 2, 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. SB 1323 updates our advanced directive laws. I'd like to move this forward, adopting several amendments offered by the Department of the Attorney General as well as adding a new defective date. Questions, comments, concerns? Vice chair.

Members, on SB 1323 Senate Draft 2, chair's recommendation is a pass with amendments. Any members voting no? With reservation? Chair, your recommendation is adopted.

Thank you. Next bill: SB 1411. This is really a cleanup bill making our state law consistent with the federal Medicaid law, and like to move this forward as a House Draft with certain technical amendments as well as clarification on page 3 of certain terms and also add a new defective date. Questions? Comments? If not, vice chair.

Thank you. Thank you, chair. Members, on SB 1411 Senate Draft 2, chair's recommendation is to pass with amendments. Any members voting no? Any members with reservation? Chair, your recommendation is adopted.

Thank you. This next bill is SB 1452, updating our Uniform Controlled Substances Law. Like to move this forward as a House Draft with technical amendments as well as adding a number of substances which fall within the federal guidelines that are--were not listed in the, in the draft provided to us, and also providing a new defective date. Questions? Comments? Vice chair for the vote.

Members, SB 1452 Senate Draft 1: chair's recommendation is to pass with amendments. Noting all members present. Any members voting no? Any with reservations? Chair, your recommendation is adopted.

Thank you. SB 850 provides for a study of health disparities among persons with disabilities, which I see as long overdue and much needed. Like to move this forward as a House Draft with a new defective date as well as technical amendments, and in the report language, note that should the Committee on Finance consider this bill that the recommended amount of appropriation is $550,000 for this report. Any other--any questions or comments? Thank you. Vice chair.

Thank you, chair and members. SB 850 Senate Draft 2: chair's recommendation is to pass with amendments. Noting all members present. Any voting no? With reservation? Chair, your recommendation is adopted.

Thank you. SB 1438 relates to protecting our in-home care residents, and I'd like to move this forward as is. Questions, comments, concerns? Vice chair for the vote.

Thank you, chair and members. SB 1438 Senate Draft 1: chair's recommendation is to pass as is. Noting all members present. Any with reservations? Any members voting no? Thank you, members. Chair, your recommendation is adopted.

Thank you. SB 228, relating to excited delirium. As was mentioned, this committee previously heard and passed a measure. Would like to move this forward, substituting the contents of HB 36 into the Senate measure and really take this measure to conference, assuming a committee on Judiciary agrees.

I'd like to, as I said, substitute the contents of HB 36 for the contents in the measure now and also add a new defective date. Questions, comments, concerns? Vice chair for the vote.

Thank you, chair and members. SB 228 Senate Draft 2: chair's recommendation is to pass with amendments. Noting all members present. Any voting no? Any with reservation? Okay, thank you. Chair, your recommendation is adopted.

Thank you. SB 299, relating to loan repayment, another measure we considered previously in this Senate version of the bill, I'd like to move it as a House Draft, filling in the blank--making clear that two years service is a condition of the program as well as adding a new defective date and blanking out the $30 million that is in the current bill and putting the suggested amount of $30 million in the report language. Questions, comments, concerns? Vice chair for the vote.

Thank you, chair and members. On SB 299 Senate Draft 2, chair's recommendation is to pass with amendments. Noting all members present. Any members voting no? Any with reservations? Chair, your recommendation is adopted.

Thank you. This next bill, SB 1612, relating to fitness, purpose to proceed, I think it has lots of potential, but I'm going to defer it because I've been informed by the State Attorney General that she is working with the Department of Health as well as the Department of Corrections and Rehabilitations and the Governor's Office to develop a plan to handle the patients who are undergoing fitness to proceed examinations and maybe an alternate solution to this measure.

So I'm going to defer the bill. Questions? Comments? If not, final bill: SB 532 expands the numbers of school personnel who can administer medications to students with proper training. Like to move this forward as is. Questions, comments, concerns? Vice chair for the vote.

Thank you, chair and members. On SB 532 Senate Draft Two House Draft 1, chair's recommendation is to pass as is. Noting all members present, any members voting no? Any members with reservations? Thank you, members. Chair, your recommendation is adopted.

Thank you very much, members, for participating in the hearing. Just a note that we'll have a hearing on Friday at 9:30 to hear resolutions. Thank you very much. We're adjourned.