House Standing Committee on Health

This, I don't have to shout.

Welcome to this first hearing of the House Committee on Health. I'm very honored to serve as your Chair. And just for the record, today is Friday, January 30th, and it's 10:30 now, 10:31 AM, in Conference Room 329. I'd like to welcome all of you to hopefully a productive session of 2026.

And first of all, I'd like to introduce the House Members. First of all, I'm Greg Takayama. I'm Chair of Health and proud to represent Pearl City and we have a couple of constituents in town in the audience and, and Vice Chair Lee Loy.

No, I'm just saying that most people don't realize that the vice chair of any Committee is really the behind the scenes person who does lots of the legwork and actual handling of the bills and legislation before us. So, appreciation to Vice Chair.

And I'd especially like to welcome our brand new member of the House of Representatives, Representative Daisy Hartsfield, proudly representing Waipahu and this is, I believe, her very first hearing of any Committee in the Legislature. So, welcome.

And of course, Representative Amato from Maui and Representative Chair Marten, who is—Lisa Marten is Chair of the Human Services Committee as well. So, thank you all, and the other Committee Members are monitoring us on TV and will certainly show up in due time. Just a couple housekeeping measures—not measures, but pointers.

You'll notice that unlike last session, there are no microphones on the table. There actually are microphones in the room and they're the green light things you see in the roof so everyone can hear you. It's been tested, but our IT persons will focus the hearing.

I don't think focus is the right word, but anyway, we'll concentrate the microphones on those source speaking at the table or at the testifier podium. So, we still need testifiers to speak from the podium.

We also have members of—testifiers on Zoom, like last year, and just pointers that we don't allow any trademark items on Zoom and also, ask you to stay muted until it's time for you to testify.

And as all of you know that we're all on YouTube, so we're being watched by a potentially worldwide audience, except Iran I think, and some other countries. But anyway, so ask that all testifiers try and abide by a two-minute time limit. We'll have a little timer behind us. And I also like to welcome Representative Alcos.

Welcome, guys. Good to see you.

First committee hearing. Thank you. So let's begin. And first up... Oh, let me explain that we'll take our agenda out of order because the second bill on the agenda, HB 469, relating to parking for disabled persons. We have a sign language interpreter with us for only a few precious minutes.

So we want to take advantage of her presence to take the first bill, 469, out of order. So let's begin. And 469 relates to parking placards for disabled persons. And first up we have Kristine Pagano from the State Disability and Communications Access Board. Welcome.

Aloha, everyone. Good morning and thank you. And really thank you Chair so much, Takayama for, and all of the Members, Vice Chair, and other Members of this Health Committee. Thank you so much for the opportunity. So I'm part of the Disability Communication Access Board. I'd like to also add some explanations here regarding this bill.

So, you know, the placard is two sided and it's a hang tag. It's given to a person with a disability. And the person has a valid disability and that placard is given to them to put in their car or any other kind of placard that they might be using. Anyway, they pay for their parking.

The person who has a disability and who has that hang tag, there's two different types. And if they have either one of those, they need to provide proof. The interpreter is just making sure that the person can see the testimony.

They need to be able to provide proof that they're going to be traveling. And especially if they're going to be traveling from one island to another or they're traveling within an island or they're going to the continent. And so that disability, once that disability travel placard, if it is no longer valid, that makes it difficult for the individual.

So we just want to make sure that we have this opportunity to be able to provide my testimony about the importance of this placard, the importance of this person to be able to have one, and so that it is something they can use regularly. And if you have any other questions, you can certainly contact me.

Thank you very much. Next we have testimony from Office on Aging in support. Let's see. Daintry Bartoldus, State Council on Developmental Disabilities. By the way, just for testifiers, it's actually better... You can sit up here if you like, but it's better to speak from the podium because then we get a better picture of you on YouTube. So please proceed.

Aloha, Chair, Vice Chair, and Members of the Committee. I'm Megan Han, interning for the Hawaii State Council on Developmental Disabilities in strong support for HB 469. I would like to emphasize the third paragraph of our testimony to elaborate on the fact that, just like everyone, people with intellectual and developmental disabilities, or IDD, travel inter island for medical care.

Especially for those that live on neighboring islands where treatment might be scarce, they have to make travel accommodations to arrive or park their cars at their respective airports, fly by plane, having to rent or get a taxi to get to their hospitals, and then they have to do that process all over again.

Therefore, our council sees the benefit for this bill to reduce the stress and financial toll for individuals and families with IDD to get the necessary care that they need without the unnecessary hardships. For any questions, I would like to defer those questions to the Disabilities and Communication Access Board, as they are the experts for this subject matter. Mahalo and thank you for your time.

Thank you very much. And speaking of the Disability Communications Access Board, we have Bryan Mick on Zoom.

Aloha, Chair. I'm DCAB staff. You've already heard from our Executive Director, so I'll defer to her comments. But I'm here in case she needs me to respond to any questions about the parking program. Thank you.

Thank you. Let's see. We also have written testimony from the Hawaii Disability Rights Center, Arc of Maui County, and two individuals, Susan Davis and Leilani Kailiawa. So is there anyone I missed who wishes to testify on House Bill 469? If not, Members, questions?

Chair, I have a question. I'm not sure if this question is for the board with Bryan Mick, so whoever can answer. So I understand that this would assist with planned travel. Would this bill also assist with emergency types of travel? And if not, any suggestions on how we can include that as this bill moves forward?

So if you could... So could you please repeat the question, and then I'll go ahead and try to respond to that?

Sure. So I understand this bill would assist with planned travel, but what about situations where it's an emergency travel and they aren't able to know what dates they're going to be traveling or how long they will be gone? Would this bill be able to cover that? And if not, what additional language may be needed as this bill moves forward?

Yes, I do understand that. Thank you so much. So, yes, this is... Yes, it is handled by our Hawaii Administrative Rules.

Would an amendment to the administrative rules, would it be needed so that emergency types of travel would be covered or would this bill and the administrative rules be sufficient to take care of those types of circumstances?

Yeah. So this bill needs to have something like for... This is... This bill is only focusing on travel and... Yes. And then that will... Then this bill will amend our Hawaii state administrative rules and regarding travel. Right now, we don't have anything like this regarding travel in terms of the placards or the tags.

Okay, thank you.

Maybe you could stay up there because I have a question or two, if I may. Now, I understand these placards are important, right? I mean, everyone wants to have them available, which is why we're considering this bill. My question is we also want to protect against misuse of the placards, right.

So want to make sure that if we issue these travel placards that they're not misused by other people. So it's important, I think, to distinguish the regular handicapped placard from the travel one. And so should we make it clear that the expiration date of the travel one should be clearly printed on the front side of the placard?

Yes, yes, absolutely. And also, the travel placard is related to the person who is going to be doing this. It's their... To their permit. It's not related to a family member. It's not to anyone who can ask to borrow it. It is the person who's permitted.

I understand. So to make it even more distinct, should we maybe issue the travel placard in a different color?

Yes, absolutely.

Okay. So I will make these recommendations when we consider the bill towards the end of the hearing. Thank you.

May I ask a question?

Yes, Representative Amato.

Thank you, Chair. Okay, so the blue placard is permanent. The red placard is a temporary disability placard. So if we do a different color for the travel placard, that will set it apart. Is there a standard across the country? Has this been done elsewhere where they have a travel placard?

No, there is no standard.

Thank you.

Alright. Thank you very much. If there are no other questions, let's move on to the next bill, which is actually the first bill on the agenda, which is House Bill 218, relating to hospital surgical smoke. And first up, we have the Department of Health on zoom, I believe.

Yes. Good morning. Can you hear me okay?

Yes, we can. Please proceed.

Okay. Good morning, Chair, Vice Chair, Members of the Committee. My name is Paula Cerio, and I am the Chief for the Office of Healthcare Assurance for the Department of Health. The Department stands on his testimony in support of HB 218. Thank you for this opportunity to testify.

Thank you. Do you have more to say in your testimony, are you in support of the measure or?

Yes, we're in support of the measure and in support of HAH's amendments that they will propose when they testify.

Okay. Thank you very much.

You're welcome.

Let's see, we have the Healthcare Association of Hawaii, Paige Choi. Is she on Zoom?

I am. Thank you, Chair. I'm sorry I couldn't make it in person. We—I'm Paige Choi, Vice President of Government Affairs for the Health Care Association of Hawaii. We stand by our comments that we submitted asking for an amendment. We agree with the other testifiers that measures should be taken to ensure the safety of staff.

As some of the other testifiers have noted, there are standards set out by entities such as the Joint Commission and NIOSH around surgical smoke that our hospitals are compliant with.

But we do understand if the Legislature chooses to make sure that there are policies around the use of surgical smoke, understanding that of course, there is a spectrum of procedures that generate surgical smoke and ensuring that hospitals do address those issues on a case by case basis in ensuring the safety of our providers.

So, thank you very much, and available for any questions.

Thank you. We have the Association of Perioperative Registered Nurses, Jennifer Pinnock. Is she on zoom? No, but we have her written testimony in support, as well as testimony from Bernadette Il Di Fonso in support and Tammy Ueda in support. Have I missed anyone wishing to testify on House Bill 218. If not, questions, Members?

Chair.

Yes, Representative Marten.

I have a question for Paige. So, the language to me that your suggested amendment is a little confusing. Why wouldn't you leave in there to prevent exposure by using a smoke evacuation system as appropriate and just have it all to specify that that and maybe even go into, you know, for the duration of the procedure or something?

It seems like right now, the situation is that an individual there on the ground gets to make the choice whether, whether the hospital, whether the room is equipped appropriately and whether that equipment is used.

And so, I think the point of the law is to make it less of an individual choice and have more set guidelines. So, I don't know. It doesn't seem like this language achieves that goal.

Yeah, and I, I, I appreciate that. I think our hope with the language and what we were reading in the Bill is, as you noted, to have more of a policy, right, policies in place, standard policies in place, rather than leaving it up to individuals, which we acknowledge, right, I think is an issue that has come up in hospitals across the country, which is why I think AORN is really focused on getting this type of language passed in multiple states

I can bring that back. I can see if maintaining the current language is an issue.

Where our members, I think, were coming from was that there's a wide range of procedures that generate surgical smoke. So, for example, in laparoscopic surgery, right, you're going to have a lot of smoke. You're going to be using electrical or cauterizing equipment for the entire duration.

But there are times where you may use a cautery for a few seconds. Right? And I think the feeling was that if you had to use a smoke evacuation system, even for those few seconds of use of a cautery, it might not be clinically necessary.

So, our feeling was kind of keeping it flexible for those instances where there isn't necessarily a high risk of exposure. But as you noted, still maintaining a standard in terms of hospital policy, instead of allowing it to be up to one individual. So, we can take it back.

If the Committee would like us to reconsider the original language, we can, but that was the purpose of our suggestion, was to allow for that wider range of types of procedures and exposures.

You know, was that, do you have any other questions? Okay, if I could follow up with Chair Marten's question. How about if we changed your suggested language. In other words, keep what it currently says about using a smoke evacuation system, but adding in or other appropriate, appropriate measure for each procedure? Would that be?

I think that could work. I can always bring it back, but I think that that captures the essence of what we discussed.

Okay, we'll suggest that.

All right.

So, everyone can hold their breath.

Literally hold their breath. Okay, thank you.

Thank you.

Humor on our, thank you. Any other questions? Sure. Yes, Representative Alcos.

Hi. I just want to follow up on some of the questions as well. To the public, could you explain what is surgical smoke? Like what, what do you guys do on all that? Where the smoke comes from?

Yeah, and my understanding of where the smoke is coming from, it's essentially whenever an electrical tool is used on tissue, and that will release some kind of smoke because there's liquid. I don't want to be too graphic, but essentially, right.

When you're dealing with tissue, with other matter, if you use some kind of electrical equipment, usually to cauterize, then that's when that happens with the liquid in the body, that's where the smoke is generated.

When you guys do mostly surgery or some kind of thing that you guys need to work on the body, right?

Generally, yes. It would be a procedure that's happening in an operating room, which I would assume is largely surgery.

Thank you.

Yeah, thank you, Representative Alcos. A good point. I mean, smoke is kind of a misnomer because it's sort of vapor or some other fumes, you know, that could be used. Okay, any other questions? If not, let's move on to the next bill, which is House Bill 814 relating to an information campaign for young people regarding cannabis.

And first up, we have the Department of the Attorney General, Michelle Nakaki.

Good morning, Chair Takayama and Members of the Committee. I'm Michele Nakata, Deputy Attorney General. The Department of the Attorney General provides the following comments on this Bill. This Bill procreates funds to Department of Health to implement a public and informational campaign on cannabis. It also requires the Department to administer grants to community-based organizations for services.

Article 7, Section 4 of the State Constitution provides that no grant of public money shall be made except pursuant to standards provided by law. If the intent of this Bill is to procure prevention and treatment services by contract, we have provided amended language in the Bill.

By contrast, if the intent is for the Department to award grants to community-based organizations, we recommend that the Bill be amended to include the appropriate grant standards. We have prepared draft grant standards for the TV's consideration, and we respectfully request that the Bill be amended as recommended. Thank you.

Thank you very much. Next up we have the Department of Health.

Good morning, Chair and Vice Chair. John Valera of the Alcohol and Drug Abuse Division, providing comments. So, we are the single state agency state that's responsible for promoting, coordinating, and delivery of care, both treatment, recovery, education, and such. We stand on our written remarks and also some amendments to the Bill. We defer to the AG on implementation.

We also just—we totally agree with the Committee that cannabis use does in fact does affect the youth development, particularly in the area of the brain. So, we want to campaign continue to work with our partners.

We will work with the other programs within the Department of Health to coordinate this public information campaign as well as deliver service treatment. Funds would definitely, if it becomes law, would definitely help expand our current service delivery. With that, thank you. Standing by for any questions.

Thank you very much. Let's see. We have written testimony from the Superintendent of Education in support. Department of the City, Prosecuting Attorney, Daniel Hugo, in support.

Hi, I'm Vinay McFarland on behalf of the Prosecutor Office for the City and County of Honolulu and we are in support of House Bill 814 and—good morning, Chair, Vice Chair, Members of the Committee. Excuse me. We are in support of House Bill 814.

This Bill is one that we can get behind because we have firsthand knowledge of the consequences of youth substance abuse in our community.

And any program that can get ahead of it and be proactive and helping keep our keiki and youth out of our courtrooms is something that we can definitely stand behind because as we know, the legalization is happening countrywide and it's appearing as if it's okay to our youth to use this, not knowing the harm and the long term effects of cannabis use.

And so, I think this campaign, I think it's going to reach where it needs to be and we are definitely in support of it. Thank you.

Thank you. Alan Johnson, Hawaii Substance Abuse Coalition.

Good morning, chairs, Vice Chair, distinguished Members. I'm Alan Johnson with the Hawaii Substance Abuse Coalition. We advocate for this increased funding for youth cannabis prevention and treatment. We want to remind that prevention and treatment that are in this Bill, they go together because they complement and reinforce each other as public health strategies.

We see that the cannabis policy is evolving, but we also see the public perception is still very mixed with more education need. Too many families and youth in Hawaii still think it's safe for their kids. It's not. Our concern is that children need to be protected from preventable harm.

And we all know that kids' brains are adversely impacted and it'll likely hurt for decades. But so many families, they don't understand that it's way, way more harmful to kids than it is to adults. Moderately for adults, but really, really hard on kids. And it's important that they learn that.

And there's so much high potency, they're using vaping and edibles in schools. It's just really getting out of control. We see that happening everywhere. We do recognize that the rate overall is stable, but it became very high and then just stabilized. And there's a reason for that.

You know, other states that legalized it and as they legalized, the rate went up for you. And so, there's new studies that are saying yes, that cultural shift caused that. There was no direct correlation, that's true, but there was a cultural shift, I think in the state.

Those states who legalized it then invested the small states, 5 million to the big states, 15 million for a number of years. And they effectively brought down the use of informing the families. They brought significant decreases in kids' use. We are here at that juncture where it's not low, becoming high. We're already at the high level.

A significant investment is shown in other states. It could bring that down, so it can work here. So, we also have great treatment here, proven effectiveness with decades of science and infrastructure in place. We have a school-based program.

I don't know if you're aware of that, but we are one of the top number one states in the nation for treatment for adolescents. So, in summary, I'm out of time. Prevention reduces future need. Treatment addresses current harm. The funding we do have came from you folks. Thank you, thank you, thank you.

We need a little bit more to keep up with the current times. Thank you.

Thank you, Mr. Johnson. Let's see. We have testimony from Big Island Substance Abuse Council, in support. Brian Baker, Hina Mauka.

Aloha, Vice Chair and Committee Members. My name is Brian Baker, President and CEO of Hina Mauka. and a Member of the Hawaii Substance Abuse Coalition. As cannabis policies change, prevention and treatment must keep pace, especially for our youth.

Today's cannabis is more potent, it's easier to conceal, and it is perceived as extremely low risk, even by as early as middle school children. Early infrequent use harms developing brains and increases the risk of anxiety, depression, addiction, and many other mental health concerns. We are also seeing right now more adolescents that cannot simply stop using cannabis.

Cannabis use disorder is real, it is diagnosable, and it is treatable. But youth specific prevention and treatment capacity has not kept up with the need. Investing in prevention and treatment is smart public health policy and it is smart fiscal policy.

It reduces long term health care costs, improves school outcomes, and keeps our keiki connected to the families and community. We respectfully urge your support of HB 814. Mahalo.

Thank you. Let's see. We have written testimony from the Hawaii Family Forum, Eva Andrade, in support. And just so Diana knows, I'm reading the testimony testifier list in order in which we receive testimony. So, bear with us. Coalition for a Drug Free Hawaii, in support. Bobby Benson Center, in support. Drug Policy Forum of Hawaii.

Good morning, Chair, Vice Chair, and Members. Nikos Leverenz with the Drug Policy Forum of Hawaii. DPFH strongly supports science-based education and prevention programs regarding alcohol and other drugs for residents of all ages. Similarly, we support increasing the state's capacity to provide community behavioral health services for residents, all residents, regardless of insurance status.

Substance use rates amongst the state's high school and middle school students indicate that the drug exceptionalism approach taken by this measure is under inclusive. This approach does not reflect the gravity of harms caused by alcohol and nicotine products, including e-cigarettes and smoked tobacco that are more widely used.

Excessive alcohol use, for example, is related to more than 200 diseases and conditions such as liver disease, cardiovascular disease, and cancer and accounts for 178,000 annual deaths in the US and 600 annual deaths in Hawaii. Excessive alcohol use is also responsible for lost economic productivity of 937.4 million in Hawaii.

Tobacco smoking remains the leading cause of preventable death in the US with significant cost to citizen medical care, 611 million annually at the state level.

Most of our US residents now live in the jurisdiction that's implement—implemented—adult use cannabis under state laws and the experiences of those locales should help inform ongoing policy deliberations and this includes the allocation of education, prevention, and treatment resources.

States that dedicate a portion of tax revenues from adult use cannabis sales to support behavioral health treatment include Alaska, California, Connecticut, Illinois, Montana, New York, Oregon, and Virginia. Mahalo for the opportunity to provide testimony. Happy to be here.

Thank you very much. Let's see, we have testimony from several individuals offering support. We have Mary Elizabeth Pacheco on zoom.

Good morning. Aloha, Chair, Vice Chair, and Members of our Committee. My name is Mary Elizabeth Pacheco, and I am here in support, strong support, of HB 814, which addresses both prevention and treatment for cannabis use and cannabis use disorder among Hawaii's youth.

I come before you not just as an advocate, but as someone who witnesses every day how cannabis use affects our keiki, our ohana, our schools, and our communities.

The data is clear and concerning. Hawaii's most recent youth substance use, findings show that nearly 1 in 10 high school students, that's 9.5%, use cannabis alongside nicotine in the past 30 days and 5%, which is 1 in 20, use cannabis along with alcohol and nicotine during the same period.

These patterns are significantly more common among youth who report depression, highlighting the close connection between cannabis use and youth mental health. What's critical to understand is that this does not start in high school.

Cannabis youth often begins earlier with vaping and experimentation emerging in middle school, long before youth fully understand the risk to their developing brains and before families realize how quickly patterns can form. At first glance, these numbers may appear small, but each percentage point represents real Keiki, real Ohana, and real consequences.

And without sustained investment in cannabis specific prevention and youth focused treatment, we don't have to imagine what happens next. We're beginning to see it. So, to put this into context, this often looks like a middle school student who starts vaping THC because peers say it helps with stress or sleep. Over time, use becomes more frequent.

So, by high school, cannabis use may be daily, sleep worsens, motivation drops, grade slips, and family conflict increases. So, by the time help is sought, the youth is often struggling with anxiety or depression and feels overwhelmed and unsure how to stop.

Clinically, we know that early and frequent cannabis use can impair memory, learning motivation, as well as emotional regulation during critical stages of brain development. So, for some youth, cannabis youth progresses.

I'm going to ask you to please wrap up, if you would. Thank you.

All right, so the bottom line is that this is not a problem for some Committee. It is really shared Kuleana, meaning I am in support of this, and I hope that you all will support this as well. Mahalo.

Thank you so much. Let's see, that's all the testimony we've received. Anyone else I missed who wishes to testify on HB 814? If not—and before we go to members' questions, I just want to mention that in case you're reading the Bill, this Bill is a carryover bill from last year.

So, references, in fact, all the bills on today's agenda are carryover bills. So, if there are references to appropriations for—that are out of step by one year. So, we'll address that, should the Bill move forward. We'll take care of that and amendments.

So, members, any questions? Representative.

Thank you, Chair. Question for DoH, Department. Question—what is the Department of Health currently doing in public education? The Bill talks about cannabis specifically, but in substance abuse and public outreach. What is your Department doing currently in relating to public education on substance abuse, specifically to cannabis use?

We have some like social media camp that we put out, say in January is substance use treatment month. There are substance use prevention months that we seriously intend to do more social media outreach. We are working with one of the major media outlets to post commercials and such. Oh, public service announcements, we also have as part of our prevention contracts some of them do media campaigns as well on their own.

And we have a list of our prevention providers. So, if you would, if you'd like to.

So, that's, that's prevention contracts and providers. Is that in fulfillment of the Act 116 from 2018 which was passed—that was referenced in one of the testifiers here today. I think in that act, from 2018, says that the Health Department is to provide science-based information in relation to medical cannabis in specific.

So, is your Department currently fulfilling Act 116 in providing science based information on medical cannabis to the public?

I have to check on that. It may be, you know, this medical cannabis is regulated by another DoH program. I think they would be the lead for that.

Alright, thank you.

Representative Alcos.

Hi. With the increase of funds that you guys are requesting for, is it mostly going out to messaging again and committing awareness in helping our kids or what are you going to plan with the increase of funds?

So, with the AG's amendments to change grants to contracts, we do have, the vast majority of the funds are going towards service delivery, treatment, recovery, as well as prevention. So, we are currently looking at developing what information campaigns we have dealing with cannabis use for young people and then, we are developing a similar campaign for the parents.

You said a little bit about recovery. Can you tell me a little bit more, what do you mean by recovery? How are you helping on recovery?

So, we operate a, a clean and silver home registry. And so, any—it's open to any home operator or owner who wishes to pull themselves out as a registered clean sober home. It's based on national standards from National Association of Recovery Residences.

Narronline.com and—but we also some of our providers that we work with regularly do have their own homes. And so, whether they need a home or whether they need outpatient, you know, so recovery comes in many different forms, many different stories.

So, we try to work with what's best for the client and support—encourage our providers—to do everything they can to support the client, whether they need a home or, or whether they need outpatient or other sorts of things.

Thank you.

Members, any other questions? Yeah, Representative Marten.

Just following up a little bit on question about treatment. When we talk about treatment that is specific only to marijuana use and not nicotine, not alcohol, or these other things, what treatment is available? Is that just counseling?

So, treatment includes a wide variety of services. There are about two or three dozen different services that a provider could give from residential to, to.

These are kids, they're probably not going into residential just because they smoke too much, right?

Yeah. If it's specific to the Bill, there's—it's mainly we're talking about intensive outpatient or outpatient services for like school-based youth or, you know, so.

And what is that service? Is that counseling? I mean, you can't do a nicotine patch or there, you know, it's not like heroin where you can have substitutions, like what, what is it? Just a counseling? Just trying to understand what treatment means.

It can be more counseling. I believe it includes groups as well, individual counseling.

Thank you. Thank you, Chair.

Thank you. Any other questions? If not, I have a question. In your testimony, in the last paragraph, you mentioned that the Department recently launched a statewide cannabis youth prevention campaign. How much money are you spending on this?

I have to get that for you, Chair. We are working with the Medical Cannabis Office on it, so.

And is this a ongoing program? Is it, you know, just a temporary one or is it multi year in focus?

It's multi year.

Okay. Yes.

So, I believe we're in the second year.

You're in the second year?

The first year, they have a late start, so they don't really do much other than getting the contract up. I mean, they get—it was a late start getting the contract started. And so, I believe we're, we're in the second year.

So, I'm just wondering if we're duplicating efforts by enacting this Bill when you already have an existing public information campaign for youth.

So I think this bill would definitely supplement our efforts. If this bill passes, we supplement our existing efforts.

Thank you. I'm going to ask department if you could forward information about this ongoing current campaign to me, if you would. Thank you. Members, any other questions? If not...

One more, Chair. Just one more, sir. How much more are you asking per year on the increase on this? You're not asking for...

So right now, based on... We can work a plan out as to how much we need specifically because this is not...

Members' information. The amount proposed in the bill is $2 million for the information part of the campaign and $5 million for the actual treatment part of it.

Already seen some of that, but it was a little bit confusing.

If I may please follow up on after the Chair to follow along the Chair's questioning. Do you have any data supporting how effective your ad campaigns are? Do you have market data to see that you're actually reaching our students and our youth, that your campaigns are effective? Just want to make sure that this money is going to an effective campaign that's doing what it's supposed to do.

Part of our existing campaign involves the expectation that these metrics will be covered. So depending upon where we are in the rollout, we will expect to have those metrics. I'm just not sure as to what phase, what stage. I believe we're in the beginning phase for the education to the website to reach the adolescents, the youth. You know, there is a similar thing in development to reach the parents. But the contract does specify metrics.

Sorry, Chair. Thank you, Chair. For DOH, in terms of trying to educate students, does DOH have any collaboration with the Department of Education in terms of trying to reach students in school or trying to work together so that, you know, we know that at least students in public schools can get the information that DOH wants to share.

We can certainly reach out to them. I believe I have to get back with regarding how, just whether we work with the DOE on this particular project. But definitely that dissemination is important.

Okay, thank you.

Thank you. Oh, and for Members' information, I misspoke slightly. The amounts requested in the bill are $2 million for public use information campaign, $5 million for contracted prevention services, and 5 million for treatment. Anyway, any... If not, let's move on. Oh, go ahead.

I apologize for jumping in this late. Department of Health. So I'm looking at the Clear the Haze campaign that you noted in your testimony. It's fantastic that you guys have this resource available. And I wonder what it looks like in physical format. The website's nice.

It definitely speaks to the youth. Since it seems like we're compounding this campaign with extra layers of support, one thing I'm very concerned about right now is other drugs, particularly things like fentanyl. So there are schools that have days called Fentanyl Fridays that are circulating amongst the youth.

If we add more funding to a program for marijuana, which already has an established campaign that's running right now, are we doing something very similar for other common use drugs that are used amongst youth in particular to things like fentanyl?

So we have, in terms of public education for other substances...

Just for youth in general, we'll take the education part out. Just targeting youth of a certain age that would be more prone to using these substances in school, out of school, regardless.

I think we certainly can do that. The contract is more specific to cannabis use, but... We'll work with our prevention team to get out.

Right. I'm just asking, do you guys have current campaigns out there to address more severe substances that are being used by youth right now? So we have a marijuana one. It's fantastic. I see it. Do we have ones for things like the drugs that I described?

We do have a website for our Hawaii Overdose Initiative that has some stats describing the latest overdose data that we have. In terms of something on the caliber of the a site, I'll have to check. I know that we are working on it.

Thank you. Thank you. Any other questions? And just for Members' information, we have a couple other measures that we'll be considering later this session regarding mental health services specifically targeting youth. And certainly we can look at the language to see if they can encompass substance abuse as well as other mental health issues.

So just for Members consideration. Okay, thank you. If no other questions, let's move on to House Bill 1452, adding advanced practice nurses to the list of health providers who can file birth certificates. First up, Department of Health.

Good morning, Chair, Vice Chair, Members of the Committee. It's a pleasure to be before the House Committee on Health and we look. Forward to productive session. My name is Lauren Kim. I'm the planning and policy officer for the Department of Health and as always a proud resident of House District 34. The Department coming from Pearl City.

The Department supports this measure. This is consistent with over 15 years of public policy that were appropriate and seeks to authorize APRNs to conduct healthcare transactions that were traditionally solely the realm of physicians. So this is very consistent with long standing community standards of practice and we support this Bill as currently drafted. Thank you.

And I'm available for questions.

Okay, thank you. Let's see. We have Sandy Harjo Livingston, Hawaii State LGBTQ Commission on Zoom. Not present. Okay. Hawaii County Council, District two Council Member Kagiwara in support. Stonewall Caucus of the Democratic Party of Hawaii. Abby Simmons on Zoom. Please proceed.

Good morning, everybody. First of all, my name is Abby Simmons. I'm Chair of Stonewall Caucus. My pronouns are she, her, I'm. I'm speaking in strong support of this bill. I think it's common sense and it just extends the responsibilities of these transactions to APRNs. So we're not really changing any other legislation beside that.

So it's a common sense bill and we stand in strong support.

Thank you. Hawaii Health and Harm Reduction Center, Nikos Leverance.

Aloha Chair Vice Chair Members, Nico Sleavers with Hawaii Health and Harm Reduction Center in strong support of this bill. This bill is needed to expand the opportunities for trans persons to obtain birth certificates that comport with their gender identity. H3RC has APRNs on staff in our Kakaako Clinic who serve members of our island's trans community.

In contrast to developments on the continent, Hawaii should continue to ensure that trans persons and other sexual and gender minorities are able to access need care and social services and also participate fully in civic and economic life for the opportunity to provide testimony.

Thank you. See, I believe on Zoom we have Shonda Brack. Not present. Okay, let's see. I should note that we have written testimony from individuals. I counted about three dozen or closer to 40 in all of them in support of this motion. Have I missed anyone who wishes to testify on House Bill 1452? Chair? Yes, Mr. Golojuch.

Hello. Aloha. Thank you.

This is Michael Golojuch Jr. And President of Pride for Hawaii. We are here in strong support of this bill.

I'm not gonna belabor the issues that have already been brought up, but we do wanna make sure that everybody knows that earlier this year the Limnick Institute has said that America is on the beginning of a genocide genocide process for our trans Mahu and gender non conforming individuals.

The reason I bring this up is that this bill will help send a message to our Mahu transgender and gender non conforming ohana members that they are part of this. We are going to lower the barriers for them to be able to get their foundational documents that they need.

I just got back from a D.C. conference and the fear is real out there with for our Mahu transgender and non gender conforming individuals when they travel that if Their documents don't match that. They could be denied access to airports. Denied. And be denied access to bathrooms. And so APRNs are the backbone of our healthcare industry.

And without this modification, it will leave way too many of our individuals without ability to access this, this, this law that we already have on the book. So this is just common sense legislation and we encourage you to pass it. Mahalo.

Thank you. Now again, did I miss anyone else wishing to testify on this bill? If not Members, any questions? Chair, representatives, Director. Of Health?

If this bill passed, how is it going to protect parents rights? What if young children want to go and change their birth certificate? Or how is it going to identify who was that person at the time of birth?

So existing statute lays out procedures for the chain of custody of vital records, including sealing original birth certificates. So those procedures are not going to be affected by this.

What's important, I think, to highlight here is that whether it be an APRN or a physician, that they have a bona fide provider patient relationship, meaning that the APRN in this case knows the individual's medical history, has attended to this person, and is making the best clinical decision that they can make.

So existing procedures have already been laid out. It simply adds the advanced practice registered nurses to those classes of providers who may document this record.

Thank you. A little bit confused. Maybe take it a little bit slower for me. So that child can change their birth certificate or anyone who wants to change that gender. They may be able to if they exit as choices they want to.

But you're saying, right, so it requires a clinician, in this case a physician, and if enacted, an advanced practice registered nurse, to essentially corroborate the medical information. So what happens before that point is between the provider and the patient and.

The family, and a parent has no control over that. And it would be if they're like 17 years old or 15 years old and want to do a change, and if the nurse or doctor says, I, I'm okay, you can do it. Parents cannot control that.

You know, I, I'm unable to comment on that. This is, you know, the Department is a steward and a custodian of vital records.

How it, how it gets there, if there's a legal process or some other process is outside the scope of our testimony, and that really is, I think you're getting at a family healthcare decision that the Department does not get involved with.

So once it gets to our doorstep and we see that passes the legal requirements for us to go ahead and effectuate this change, we do so without necessarily understanding or having Knowledge of the Medical history before that.

If an adult changes birth certificate, applies for a male or kind of female job, that it would require more of a male or female, their birth certificate will qualify for who they are.

That gets more into employment law and I'm not trying to evade the question, but that's really outside of the scope of the Department of Health. If a future employer requires a birth certificate as part of onboarding, that's business decision of theirs. I'm not aware that that's the case. Yeah, it's, it's. That's an area of employment law.

I think that I'm not prepared to testify and that's not our expertise. Sure. Thank you.

Same person. Thank you. Question. So since your Department does handle the. Dispensation and record keeping of vital records. Currently, if a minor wants to change. Their gender on a birth certificate, does that require parental consent or through your Department?

My initial reaction is no, but I'm going to confirm. I need to confirm that if the request to amend a birth certificate shows up with corroborating documentation from a licensed healthcare provider, I believe that is all that is sufficient. But I need to confirm that and I'll get, I'll send that information to this community.

For adults, it makes sense, their own whatever. But for minors, you would think for. All government records, documents changing things would require parental consent. So the fact that that isn't, I. Guess, certain on your part is actually quite alarming. But.

Well, that's, that's my ignorance. I'm sorry, I'll need to look into that and I'll get that information back to the Committee. Thank you.

Just remember that. I just want to clarify that the sole difference in this bill is that it adds EPR to the list of existing health providers. It doesn't make any other changes to current procedures. Members, any other questions? Okay. If not, let's go on to the final bill on the agenda which we saved close to lunch.

And it deals with disposal of human remains and It's House Bill 1481. And we have first up, the Department of Health.

Morning, Lauren Kim representing the Department of Health. The Department supports this measure and I'm available for questions. Thank you.

Thank you. I believe on Zoom we have Jay Morford, Hawaii Funeral and Cemetery Association.

Good morning, Chair Takayama. My name is Jay Morford. I'm representing the Hawaii Funeral and Cemetery Association. Today we stand on our testimony of support for this measure and I appreciate you hearing the bill. Thank you. Thank you. Let's see.

We have testimony from several other mortuaries here in town. All of them in support. Did I miss anyone else who wishes to testify either in person or in Zoom on this bill HB 1481 if not Members questions?

Chair, I'm sorry neglected to share with the Committee that we are suggesting amendments that changes the shall complicate administrative rules to May. We can work out with industry the policies and procedures to effectuate this change without administrative rules.

And if we are required to promulgate administrative rules, it may delay the administrative simplification that this measure is trying to achieve. So I'm sorry, I forgot to highlight our amendment from shell to me. Thank you. All important shell to me.

Any other testifiers if not Members questions? Seeing none. If I could ask Mr. Morford a question. You know this, this bill really originates from you folks. So could you perhaps for the benefit of the Members explain why you are suggesting that the current lobby amendment.

Sure, I'd be happy to. Currently in the state of lying under statute we're required if there is. If there is no direct written instruction from someone that's passed away, we're required to get all of next to Kin's authorizations for any type of disposition that'd be burial or for cremation.

That can cause us a lot of challenges when it comes to scheduling, especially when we're trying to coordinate with crematory cremation or trying to schedule burial the cemeteries. Hawaii State Punchbowl, whatever cemetery entity we're looking at.

What this will allow us to do is apply for the permit, give us 60 days from the date that we apply for the permit to continue through the authorization process with the families and and coordinate scheduling with them with the families that's more agreeable to them than possibly waiting when we have allotted time to be able to get the burial that the cremation schedule.

That's the intent behind the change. Thank you.

So as I understand it, you're still required to dispose of the body within 60 days as permitted. You simply remove the exact date on which within those 60 days the service or whatever.

If we were in a situation where we could not do a cremation or do an interment within that 60 day period, we would then be required to do an affidavit with the Department of Health to change the burial permit authorization time which would restart the 60 days again.

So yes, to answer your question, we're required to do it within the 60 days.

Okay, thank you. Any other questions Members? If not, let's move on to decision making. I think. Do we need a recess? Okay. Okay. So if we can move on to decision making, beginning with the first bill on the agenda, House Bill 218 relating to smoke procedures in hospitals.

My suggestion is that we pass this as a House amendment adopting the language from the Health Care Association with suggestions that were provided by Chair Martin as well as myself.

In other words, keep the existing language which says hospitals shall adopt and implement policies to prevent exposure to surgical smoke by using a smoke evacuation system and adding this language or other appropriate measure for each procedure that generates surgical smoke. That's my suggestion. zero, and also add a defective date.

We are going to adopt a defective date of 7-1-3000. Just remembers for audience information. We added defective date to indicate in the bill that the work on this bill is not complete. So that's why it's called a defective. So, Members, any questions, concerns or comments? If not Vice Chair for the vote.

Thank you. Chair recommendation voting on House Bill 218. Chair's recommendation is to pass with amendments. [Roll Call] Garcia thank you Members. Chair, your recommendation is adopted.

Thank you. This next bill is HB 469 relating to parking placards for disabled persons. My suggestion is that we adopt this as a House draft, adding the suggested language from the Disability and Communication Access Board, which provides a definition of disability travel placard.

We also want to make it clear that in the definition, the disability travel placard should have the expiration date clearly printed on the front side and as well should to the extent possible, be a different color from the current placards, non travel placards and also at a defective date. Any questions, comments or concerns? If not thank you.

Thank you Chair Members voting on House Bill 469. Chair's recommendation is to pass with amendments. Any Members voting no?With reservations? Chair, your recommendation is adopted.

Thank you for this next bill, HB 814 relating to Canvas cannabis. I have a couple suggestions to be included as a House draft. Number one, shorten the preamble, but keep the essential meaning and intent. Second, adopt the AG's recommendation to change use of the word grants to contracts instead to simplify the process.

We also want to have separate sections for each of the contract campaigns to specify what they should include. Also, update as far as the appropriations that are recommended. Make them clear that it's only for FY27 and the figures would be $2 million for informational campaign aimed at youth. $5 million for prevention and $5 million for treatment services.

Finally add a defective date and I think that's it. Members, any questions, comments, Concerns?

Representative?

Clarifying on the budget. So it's 2 million for prevention campaign.

And then 2 million for informational campaign, 5 million for prevention, 5 million for treatment.

Thank you.

Beginning with Representative Alcos and then Representative Hartsfield.

Sure. I like the idea that we helping off the youth and trying to figure out what ways we can do it. I don't like the where our plan is in marketing with them or trying to.

I want to see more help and I feel that we're losing the battle against cannabis and our kids. I want to see more effective ways that we can support and help them. I want to go reservations just because I feel that we need a stronger system. Thank you.

Representative Hartsfield.

If I could comment. You know, I agree that we're losing the battle, but my concern that we're not even putting up a fight. So understand that's the behind the bill.

Thank you, Chair. I also appreciate the intent of the bill as well as the spirit of it. I have some reservations in terms of the amount of money that's appropriated because I don't feel comfortable that there is a clear plan on how that money would be spent. And so that's.

That's the only reservation that I have at this point.

Thank you very much. And just a reminder that this, this bill does move on to finance afterwards. So any other comments, questions or concerns, if not, please cheer.

Thank you, Chair. Members voting on House Bill 814. Chair's recommendation is to pass with amendments noting reservations from Representative Hartsfield and Representative Alos. Any other Members with reservations? Reservations. Thank you. Reservations. Thank you. Any voting? No. Thank you, Chair. Your recommendation is adopted.

Okay, thank you. This next Bill, HB 1452 relating to birth certificates. My suggestion I our recommendation is that we move this forward as a House draft, defecting the day. Questions, comments or concerns? If not question.

Thank you, Chair. Members voting on House Bill 1452. Chair's recommendation is to pass with amendments. Any Members voting with reservations. Any Members voting no. Thank you, Members. Chair, your recommendation is adopted.

Thank you. The final bill is House Bill for 1481. Disposal of remains. My suggestion as we move this forward as a House draft adopting the DOH suggestion that we change shall to may to enable them to make the change under existing rules. Questions caught out and defecting the defective Questions, comments, concerns, if not Vice Chair.

Thank you, Chair. Members voting on House Bill 1481. Chair's recommendation is to pass with amendments. Any Members voting with reservations?

Right here, reservations.

Thank you Member. Any voting? No. Thank you Members. Chair your recommendation is adopted.

Thank you all.