House Standing Committee on Health

Good morning everyone. Welcome to this morning's hearing of the House Committee on Health. We are present in room 329 and it is Wednesday, February 11, 9am welcome all of you for being here this morning. Just some housekeeping reminders. Number one, you'll notice that unlike previous years here at the Capitol, there are no microphones in the room.

So we ask that when you testify, you come up to the podium and speak in a clear voice. The mics will pick you up. There's a green lighted devices in the ceiling and they're, they're very good at picking up voices. But we do ask that you speak clearly.

And for the audience Members who are listening rapidly to the testifiers, we might remember that the mics can pick you up as well. So please try and keep your comments to Whispers.

Also for those on Zoom, we ask that you keep yourselves muted until you're queued up and ask that you not show any trademark items because we are being televised to a worldwide audience on YouTube and YouTube discourages that.

Now we have many bills before us, so I ask that testifiers abide as well as they can to minute time limit their testimony. That will make sure that we have time to hear all of you as well as leave time for questions.

So first up, we have House Bill 1871, relating to establishing a maternal health monitoring pilot program. And we have the Department of Health. Offering comments. Okay, let's see. Hawaii State Commission on Status of Women offering support. On Zoom I believe we have the Hawaii Affiliate of the American College of Nurse Midwives.

Aloha. Thank you for this opportunity to provide oral testimony. We stand by our written testimony. I wanted to bring to the attention the work of the Healthcare Providers Barrier to Practice Review Task Group. In the work of that group, they reviewed various legislative, existing legislative statutes where it was deemed appropriate to adopt provider neutral language.

So for example, where a healthcare provider might have been utilized, it could be replaced by qualified healthcare provider. And the meaning of that would be any person with a current active license or certification issued under Title 19 or Title 25 whose scope of practice as defined by any applicable law and rules adopted thereunder or authorizes the person to provide the health care services described in this chapter.

As a legislative representative for the Hawaii Affiliate of the American College of Nurse Midwives, we want to reiterate that midwives are some of the primary providers of care for prenatal and postpartum care, and we don't want to be excluded from a very valuable pilot such as this.

So in our written testimony we supplied a replaced definition of the healthcare provider and including the remote, the definition for the remote monitoring clinical care team where it identifies nurse. We provide the suggestion that a qualified healthcare provider could also be in place. That would potentially expand access to this pilot project for all providers to engage and serve the Hawaiian people. Thank you.

Thank you very much. And for the record, your name.

Oh, I'm so sorry. Thank you. My name is Margaret Ragen. I am a certified midwife and the legislative contact for ACNM.

Thank you. Next on Zoom, I believe we have Christine Perez, Maternal Health Clinical Lead. Please proceed.

Good morning. Thank you for having me. My name is Christine Perez. I have a PhD in public health and a nurse for 30 years of maternal child health. I also have 30 week preterm and have lived a long time implications including asthma as of today.

The March of Dimes reports 25% of counties in Hawaii have hybrid or preterm births and chronic health conditions. Chronic health conditions increase the rate of preterm birth by 34%. Obesity, hypertension, and diabetes are all leading contributors to preterm deliveries. They also increase the risk of maternal mortality, stillbirth, C sections, postpartum hospital readmissions.

Remote monitoring has been shown in studies to reduce C sections, decrease ICU length stays, and improve adherence to medication, as well as it increases postpartum visitation guidelines, which are typically only met 40% of the time due to a lot of access barriers to care.

The Center of Healthcare Quality and Payment Reform January 2026 reported that moms in Hawaii can average time of travel to 68 minutes to care. Remote monitoring provides an additional avenue to access care. Meeting people where they are utilizing cellular devices also helps eliminate any Wi-Fi shortages issues or data plans.

Philips has partnered with Georgia to implement a similar pilot. And I can tell you some of the main things that have been a benefit of the program is really maternal empowerment where they understand their diagnosis better, what target blood pressure, glucose they need to have urgent maternal warning signs, the need for low dose aspirin.

There's also someone at the other end monitoring the measurements that they have, whether it's glucose or blood pressure, 24/7 and notifying them and talking with them into understanding if they're having any urgent signs that need emergent care and managing that condition. For all of these reasons, Philips respectfully urges the passage of HB 1817. Thank you so much.

Thank you. Let's see. We also have written testimony in support from the March of Dimes and an organization called AdvaMed. That's all the testifiers I have listed. Anyone else wishing to testify in this measure here or on Zoom? Seeing none. Members, any questions? Seeing none.

Let's move on to the next bill, which is House Bill 1977, requiring Department of Health to establish a maternal and infant health information mobile app. And first up, Department of Health. Let's see. Hawaii State Commission on Status of Women in support. American College of Nurse Midwives on Zoom.

Aloha again. My name is Margaret Ragen. I am testifying on behalf of the Hawaii Affiliate of the American College of Nurse Midwives. We stand by our written testimony. We are requesting inclusion of the organizations through which people will be able to access resources.

The American College of Nurse Midwives has online resources that and position statements for over 63 different conditions related to women's health and pregnancy. Some of the other organizations do not have all of these resources actually publicly available if you are not a member, but ACNM does provide those. So we hope to be included within other organizations such as CDC, NIH, ACOG, AMA and AAP. Thank you.

Thank you. We have Manny Heer from Philips on Zoom.

Yeah, hi. Good morning, Chair Takayama, Vice Chair, and Members of the Committee. My name is Manny Heer and I'm here on behalf of Philips Healthcare in support of HB 1977. Philips has a long history in maternal and infant health, from our hospital based ultrasound and fetal monitoring technology all the way to pregnancy plus.

It's an app as in that's most widely used in terms of the pregnancy apps as far as it goes globally. So nearly 4,000 expectant families in Hawaii use our app. They use that in 2025. As you all know, when someone finds out that they are pregnant today, one of the first things they do is that reach out for the phone. And we believe the HB 1977 recognizes that reality.

And this bill, this bill, as you know, allow the Department of Health to procure a maternal infant health mobile application for Medicaid eligible prenatal, pregnant, and postpartum individuals and their families. Other states are already leveraging similar pregnancy apps to better connect their Medicaid families to services, state services.

States including Michigan, Arkansas, New York, and these states have used mobile platform to increase awareness of their home visiting, nutrition programs, and other maternal health resources. So for example, Michigan leveraged Philips pregnancy app to promote awareness of the state based programs like the home visiting. The app connected with 3200 Michiganders who are on Medicaid.

Information about the state programs was seen on the app over 2.25 million times and over 3,000 moms were referred to home visiting. So and through the service from the app, about 50% of the users said that they learned more programs about the state programs from the app. So Hawaii already invested in important maternal health programs.

The challenge is often with awareness and navigation. A mobile app can serve as a trusted, centralized entry point, helping family understand their benefits, connect to the state resources, and stay engaged throughout the pregnancy and postpartum. So for these reasons, Philips respectfully urges the passage of HB 1977. Thank you very much.

Thank you. Thank you. Let's see. We have a written testimony from the March of Dimes expressing support. Anyone I missed? Anyone else wishing to testify in HB 1977? Seeing none. Members, any questions? Representative Hartsfield.

Thank you, Chair. Department of Health. Thank you for your testimony. I do have a question in terms of implementation. If this bill were to pass, how much time would the department need in order to implement what this bill proposes?

...

Thank you. Do you have no further questions? Thank you.

Any other questions? Seeing none. Well, thank you very much. Let's move on to the next bill, which is HB 1858, relating to certificate of fetal deaths. First up, we have the Department of Health.

Good morning, Chair, Vice Chair, and members of the committee. <inaudible> testifying on behalf of the Department of Health. The department supports HB 1858 with amendments. This is a fairly consequential measure that will allow-- improve better, greater quantity and precision data being collected and revised. We are unable to dig as deeply as we would like into the upstream process of this and this measure will allow that by aligning <inaudible> methods being consistent with national best practices.

However, as currently drafted, this measure creates significant administrative barriers and the department has recommended some amendments that negotiate with stakeholders and there appears to be consensus amongst stakeholders <inaudible>. Urge this measure to move forward with our amendments and I'm available for questions. Thank you.

Thank you. Let's see. We have written testimony in support from a number of organizations. I'll read some of them briefly: Hawaii State Commission on Status of Women, Hawaii Funeral and Cemetery Association, Hawaii Medical Association, Hawaii Pacific Health, Hawaii Amendments Coalition. Let's see. On Zoom, I believe we have Dr. Joy Vink.

Good morning, everybody, and thank you, Chair Takayama and committee members for hearing this bill and your time. I am Joy Vink. I'm one of the high-risk OB/GYNs over at Kapiolani, so I deal with a lot of the complicated pregnancies here at the hospital. I actually grew up here.

Sort of a backstory: I moved home a couple years ago, and here at Kapiolani was actually very shocked to see our high rate of fetal death that was happening here at the hospital.

When I looked into it, actually coming across this data from the CDC saying that Native Hawaiians and Pacific Islanders have the highest rate, one of the highest rates of fetal death across the U.S. and trying as a clinician, obviously, we want to help in having a family that experiences this tragic loss of a stillbirth is very traumatic.

It is a lifelong-- has lifelong effects for the family, as well as the mom, and lasting psychological effects. So as a clinician, we really want to help in trying to figure out how we can prevent the high rate of fetal death that we're seeing here.

Unfortunately, when I actually looked into trying to figure out how we can help, a lot of that comes from the data, and unfortunately, at a state level, our data is not very good. And part of that is multifactorial.

But in having-- now being in charge of all of our fetal death reporting at Kapiolani here, as well as working with the DOH for the last year and going to all of the birthing facilities to understand the challenges that people are facing in terms of reporting fetal death and data collection, coming to find that the reasons are multifactorial, but a big one is our current fetal death reporting statutes.

Our current statutes are severely outdated, they do not align with current CDC recommendations of what we are supposed to be doing in terms of reporting fetal death, and that's part of the reason why we're facing such challenges and getting good data. So this bill is very timely. We have the attention of the DOH.

We have actually national attention as well to really understand what is going on here in our state. The time is now to revise our fetal death reporting statute so that we align with CDC recommendations and do what we are supposed to do to actually get good data, and once we get the data on the clinician side, we can actually start to come up with meaningful interventions to hopefully help our families and our communities to prevent fetal death. So that's the purpose of this bill. I thank you so much for your time and support, hopefully. Available for any questions if you have any.

Thank you. Let's see. We have written testimony from about-- well, from 12 other individuals in support. Anyone else wishing to testify on HB 1858? If not, members, questions? Seeing none. I do have a question for Dr. Vink.

I gather the Department of Health is proposing that-- proposing to amend the bill by making physicians as well as APRNs responsible for issuing documentation of fetal deaths rather than the Department of Health. So, just want to make sure that you're in agreement with the proposed amendment from Department of Health.

Yes, we are in agreement. We have talked extensively with the DOH and we fully agree with their new language.

Now their language says that the physicians and nurses who certify the fetal death due to miscarriage may issue documentation of the fetal death. Do you have a problem if we change 'may' to 'shall?'

I'm sorry. Sorry, it broke up. Can you repeat that, Chair?

The amendment that the Department of Health is proposing says that doctors and nurses may issue a certificate of death to the parents. I'm asking if you would be okay if we change the 'may issue' to 'shall issue.'

That's fine. I think part of that statute is focusing on less than 20 weeks. That language is for less than 20 weeks or less than 350 grams if we don't know the gestational age, and that is optional reporting.

So if a family--because a lot of the families are really struggling and they don't get any sort of documentation when they have a miscarriage--in order to help them with their closure and healing, if they would like us to submit this information, you know, and give them a copy of the form that we submit, we'd be happy to do so.

Thank you.

And we don't want it to be the DOH's responsibility. It'll be ours.

Thank you so much, Doctor.

Thank you so much.

Well, with that, let's move on to the next bill, if there are no other questions. Oh. Chair Marten.

Yeah, sorry. Again for Dr. Vink. You know, in sessions past, this body has learned that our-- you know, the data gathered was insufficient to give us a good understanding of what impact home births were having on our fetal deaths.

Would this process described here change that in any way or give us any better data of a role played with a delivery that was perhaps started at home and then was transferred to the hospital because things weren't working out?

There is data on the report that we fill out at the facilities of whether or not the birth was done at home or at the hospital. So there is a way to track that. There is actually motions now to actually form a fetal infant mortality review committee in the next year, hopefully, which we will then dive into much more detail about all the fetal deaths that are occurring here in the state. So that will also give us more information as well.

But the starting point is this bill in trying to get our data better at a state level, and then obviously we will have a group of experts diving into more detail to understand all the different reasons why and hopefully coming up with interventions to prevent this in the future.

Thank you very much.

Thank you. Thank you, Chair.

There are no other questions. Let's move on to the next bill, which is House Bill 1591, which expands the definitions of preceptor and volunteer based clinical training to improve to receive income tax credits. First up, we have the Department of Health.

The department does support HB 5091, but prefers a very nearly identical measure but one that is a little more expansive, which is HB 2206. And I'm available for questions. Thank you.

Thank you. State Department of Taxation offering written comments and suggesting a couple changes, which more clearly define a couple terms that are used in the bill. University of Hawaii in support. Hawaii State Center for Nursing.

Aloha kakahiaka, Chairs, Vice Chairs, Members of the Committee. My name is Laura Reichhardt. I am the Director of the Hawaii State Center for Nursing. I also have the pleasure of administering this program. I stand in support of my written testimony, and I also want to say that I also support the testimony provided by Department of Health. Thank you.

Okay. Thank you very much. Hawaii Substance Abuse Coalition in support on Zoom. I believe we have Tom Yamachika, Tax Foundation of Hawaii. Not present. Okay. We have Queen's Health Systems in support. Several other organizations in support. On Zoom, do we have the Hawaii Affiliate of the American College of Nurse Midwives?

Yes. Oh, sorry. Aloha. My name is Margaret Ragen. I'm speaking on behalf of the Hawaii Affiliate of ACNM. Mahalo for this opportunity to provide additional testimony. We stand by our written testimony. We appreciate the work that has been done over the past two years. This bill was deferred from last year.

As people working in the health field are well aware, there's very, there's very great barriers to securing clinical placements. Within the field of midwifery, it's additionally challenging because in the state of Hawaii there are no institutions to obtain an advanced practice midwifery credential.

So the majority of students who are from Hawaii will enroll in programs on the continent. And there are a variety that are hybrid programs available. The way that this bill is written, it excludes all midwifery preceptors and APRNs and CM, LMs. So those are certified midwives who are also advanced practice credentialed midwives.

What we are suggesting is that if it is possible to add an additional provider because the certified midwife also acts as a primary care provider, provides women's health care, reproductive health care, postpartum care, basically care from the time that a child would have their period to the end of their life.

But the way of the language of the bill, it's excluding this particular credential. But the other part is that the only Hawaii based students, so this would be for other professions as well. The only schools, students attending schools, they have to have at least 50% from the Hawaii, from Hawaii attending their school. It seems very exclusive.

If there was a way it could be amended to include Hawaii based students who are are enrolled, but they in a school on the continent. But the majority of their clinical training occurs in Hawaii under Hawaii preceptors. It could help grow our own.

Thank you, Ms. Ragen. Hawaii Public Health Institute.

Aloha, Chair, Vice Chair, Members of the Committee. I'm Kris Coffield from the Hawaii Public Health Institute. We support this bill. We're supporting all preceptor bills that are expanding this program. As you all know, there's a huge medical professional shortage in Hawaii. There's a report recently that showed that there were 833 full time physicians in need.

Hawaii County had a huge shortage, a big problem on the neighbor islands. According to recent data on Maui or Hawaii County, it would need to grow its supply of physicians by 43% to meet demand. This is a proven solution. There have been studies on this that show that since its implementation, when it's originally evaluated, there was a 77% increase in active preceptors.

So this works. We're really excited to see social workers included in this program. There was a report from the UH Thompson School of Social Work and Public Health that showed the demand for healthcare social workers in Hawaii is going to increase by up to a quarter, up to 25%.

And the need for specifically mental health and substance abuse social workers is estimated to increase by about 22% over the next 10 years. So we're really excited to see them included as well. Thank you very much for moving this measure forward.

Thank you very much. See, that's all the testifiers I have do I have listed. Is there anyone else wishing to testify on this Bill? Seeing none. Members questions. Let's move on. Next Bill up is House Bill 1574 relating to the health care education loan repayment program. And let's see.

I have to note that we have written testimony and support from the Governor. Next up we have the State Health Planning and Development Agency, Shipta, Dr. Lewin. Standard. Thank you. See we have office of Hawaiian affairs and support hawaii state nursing, hawaii state center for nursing. ... in support HMSA ... out.

Morning, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and members. <inaudible> on behalf of HMSA. We appreciate the Legislature's continued support of this very important program to help address our healthcare workforce shortage, so thank you. We stand in support.

Thank you. On Zoom, I believe we have the American College of Nurse Midwives.

Aloha. Mahalo for the opportunity to testify. My name is Margaret Ragen, speaking on behalf of the American College of Nurse Midwives. We are in support of this bill.

The concerns that we have is that, although our members recognize the importance of workforce retention and the value of service to publicly-insured populations, the concerns have been raised regarding a threshold of 30% of clients being recipients of MOC, and so we don't know how that could be adjusted. Post-graduation, midwives face challenges in securing employment.

Though midwives have a scope of practice that allows them to practice in hospitals, clinics, in birth centers, and in the home, it is not always easy to secure that job, and yet, we are hoping that more and more midwives will apply to remote programs, be able to find preceptors in Hawaii, and then to be able to work. They would not be eligible for this if they can't secure-- if they go into private practice or they work for midwives that are within private practice.

So if there is any way to accommodate--and I'm assuming this might be true across the field, across different types of credentials where not all doctors or dentists take Medicaid clientele--so I can't-- we haven't proposed an amendment suggestion, but we're just providing feedback that this could be prohibitive for expanding Hawaii-based providers.

Thank you very much. Thank you. Let's see. We have testimony in support from-- I see a number of local healthcare associations, including the Hawaii Medical Association, Queen's Health System, and Hawaii Pacific Health. Is there anyone I missed who wishes to testify on this bill? Seeing none. Members, any questions? No questions. Okay. Let's move on.

Next Bill is House Bill 1575 relating to Parkinson's patient air transport. Creating a feasibility Committee to make recommendations in that regard. First up, Department of Health.

Good morning. Lauren Kim, Department of Health we appreciate the intent of this measure. At its heart the solution to supporting. Individuals movement disorders traveling interisland healthcare partners is likely going to be health care or health insurance health benefits solution. That's generally not the kinds of programs that the Department of Health administers.

So in view of that we are recommending that any appropriations be redirected to dive into Parkinson's research in the state of Hawaii. There we just don't really have a. Good sense when compared with some of the other jurisdictions on prevalence and incidents and that we think that would be. A better place to start.

But we will participate in any community conversation that will improve the lives of poor residents. Thank you. And I'm available for questions.

Okay, thank you very much. On zoom, I believe we have the Michael J. Fox Foundation.

Yes, good morning and thank you Committee Members. Special thank you to chair Takayama for authoring this important Bill. My name is Jared Girusso cloak with the Michael J. Fox foundation for Parkinson's Research. MJFF is the world's largest nonprofit funder for Parkinson's research, having invested more than 2.5 billion globally to accelerate better treatments and ultimately a cure.

I've submitted written testimony, written testimony which I stand by. But I want to briefly lift up one key point. For many people living with Parkinson's in Hawaii, access to movement disorder specialist requires inner island travel. As the disease progresses, mobility challenges, costs and logistics can make that travel difficult or even impossible, delaying care and worsening outcomes.

This Bill makes a thoughtful step towards addressing that barrier by examining practical solutions to help patients reach the care that they need. So we respectfully ask for your support. Thank you.

Thank you, Hawaii Parkinson Association.

Thank you. Morning chair Takayama, Morning Vice chair Keoho Kapu Liloi and Members of the Committee. Glen Higa, the President of the Hawaii Parkinson association, representing the over 8,000 people with Parkinson's and their associated caregivers, families and friends and so forth.

We are in strong support of HB 1575, which would form a Committee to study the cost of transfer transporting labor island in patients with Parkinson's disease by air to Oahu. You know, I'm fortunate that I just live a few miles away from the only movement disorder clinic here on Oahu. But I'm not seeing you.

There's a number of neighbor island people that do not have access to care as much as I do. And so that's why we really stand in support of this legislation to form the Committee.

Not only is it difficult to travel for many people with Parkinson's, it's also very expensive when you consider airfare, ground transportation, sometimes lodging if you need to stay overnight. And in addition, many people living with Parkinson's need to travel with a caregiver as well. So now you're doubling the cost of this.

So we think, we feel that the creation of a state administered Fund may help offset transportation costs, provide access to care for all Hawaii residents living in Parkinson's. Addressing the Department of Health, that is true. We don't know the full scope of neighbor island care.

And that's why this Bill would help identify the number of people that this would help as well. We urge you to support this legislation. Thank you. Thank you.

See, we have testimony from the Hawaii Disability Rights center in support as well as two individuals. Anyone else wishing to testify in Hospital 1575? Dr. Loom.

Good morning. Thank you. Chair, Vice chair, Members, Jack Lewin, Administrator of SHPDA. We didn't have time with our 100 other 20 bills. We wrote testimony on this week to comment here.

But we would hope that in the future this kind of service could be allowed at least to appear on the neighbor island counties so that people would have access in that fashion. May be much less expensive and better for patients.

That wasn't proposed at this point and maybe it is impossible, but that may be where we ought to look to the future. Thank you very much. Thank you.

And I think our committee accounts for about 70% of your testimony. But thank you for being here. Anyone else? If not, Members, questions? Seeing none. Let's move on. HB 1854, relating to certification of community behavior health clinics. Department of Health.

Good morning, Chair, Vice Chair, Members. I'm Courtenay Matsu, Deputy Director of Behavioral Health Administration, Department of Health. We stand in support of this bill to certify and establish to establish this office to certify and monitor community behavioral health clinics.

The certification is necessary to allow the clinics to qualify for enhanced Medicaid reimbursements, and thus promoting their financial sustainability. The CCBH model is in operations nationwide. There are many clinics out there. What it does is it really expands the access to behavioral health services to provide care for all ages, regardless of ability to pay or insurance.

It provides comprehensive care that includes both mental health and substance use, crisis care, case management, and psychiatric rehabilitation. We feel that by establishing this office, it'll provide the department with the infrastructure that will be needed to support the expansion of this CCBHC model throughout the state. Thank you.

Thank you. On Zoom, I believe you have the Attorney General's Office. Oh, you're present.

Good morning, Chair, Vice Chair, and Members of the Committee. I'm Deputy Attorney General Michelle Agsalda. Our department submitted written comments noting that the bill does not appear to explain how the special funds satisfy the requirements of HRS section 37-52.3. We recommend adding a purpose section to the bill that explains how the special fund meets these requirements. I'm available for any questions. Thank you.

Thank you very much. Let's see, we have testimony in support from the Department of Human Services, as well as two individuals. Anyone else wishing to testify on this bill? If not, Members, questions? I do have a question for the Department of Health, Dr. Matsu.

Having noted the Attorney General's concerns about the creation of a special fund, I gather the concerns stem from the fact that when we create a special fund it's usually with the intention that the special fund be self containing. The amount that you're requesting to start up is $800,000. Do you expect that the revenues to be deposited into the special fund would make it self sustained?

So the amount requested was to support the various positions for the office. Primarily the special fund was requested in the event that we were able to have admin fees for the application and when the clinics needs recertification for those purposes and primarily to support the operating cost of sending our team out to do audits for the certification and recertification. So the travel to the inter-Islands.

How many such clinics are there right now?

Currently we have two clinics on Maui that are operating like a CCBHC. They are not yet certified because the state needs to apply to become a demonstration state with CMS. And with that designation they can then start certifying the clinics.

Right. Thank you very much. I just note that I think the substance and intent of the bill be still carried out without the inclusion of a special fund. So just...

Thank you. I also wanted to make a point about our amendment. We did amend it to change the language from populated island to populated county. We need to address that. We wouldn't be able to provide robust services to... But if we did, if that amendment did carry forward, we wanted to call attention to page 5, line 5, that we would need to change the total number of members to 9. 11 to 9.

Okay, thank you very much.

Thank you.

Let's see. There being no other questions, let's move on to the next bill, which is House Bill 1855, and it relates to establishing the Hawaii Violent Death Reporting System. First up, we have Colonel Rob Swanson.

Morning, Chair, Vice Chair, Representatives. Colonel Rob Swanson, United States Air Force retired military veteran. I run the Governor's Challenge task force for suicide prevention, I run a DOD veteran suicide prevention program called, Fight for Each Other, and I'm a member of the Prevent Suicide Hawaii Taskforce.

I'm here to testify in support of Bill 1855, and the only thing I might change is, instead of establishing, I would say re-establishing, because we had a Hawaiian--sorry--a Hawaii Violent Death Reporting System. It was terminated on the 25th of September of 2025 in part due to a lack of funding, et cetera. It is a critical data source.

Any of our efforts in suicide prevention have to be data-informed. We have to know what the causes are so we can go after them. The Hawaii Violent Death Reporting System feeds directly into the National Violent Death Reporting System. It is critical for ongoing efforts.

We have a two-year effort where we're standing up a suicide mortality review. The Department of Education is using this data to combat school violence and suicides in school, with the highest growing demographic in suicide in the State of Hawaii.

The Violent Death Reporting System includes additional things that are not in the data sets that are being proposed by the Department of Health to include the circumstances of death, which they've derived from various sources. Methods: ligature is the number one cause. Suicide is the number two means of violent deaths in the State of Hawaii.

This is just-- it's a very important thing, location, and then various populations, whether it was veterans or at-risk communities, et cetera. I have submitted written testimony in addition to the words that I have. Thank you for your time, and I'm a fierce advocate of this capability.

Thank you very much. We have written comments from the Office of Information Practices. Department of Health.

Morning Chair, Vice Chair, and committee members. Thank you for the opportunity to submit comments on this measure. So we stand on our written comments. I do want to just add to a little contents that the current Administration has caused extreme chaos and turmoil when it comes to federal funds and funding, specifically CDC funds.

This, unfortunately, was a result of that and there is a current-- currently, we had to negotiate with the CDC, reestablishing our agreement in terms. That was accomplished by December of 2025. As a result of this vulnerability, the department did recognize that we had an opportunity to improve and become self-reliant instead of reliant on the federal government systems.

We issued a HIePRO, and have a contractor currently working on integrating all of the CDC violent death registry data points into our state registry system, and believe that current statutes already exist and support this measure. And I stand on our written testimony. Thank you.

Thank you. By the way, I'm sorry; did you identify yourself?

Sorry. Garrett Hall, Chief of EMS, Emergency Medical Services, and Injury Prevention for the Department of Health. Thank you.

Mr. Hall, thank you. Let's see. Maiko Arii.

Aloha. My name is Maiko Arii. I'm a concerned former abstractor for the Hawaii Violent Death Reporting System, and I'm testifying in support of the bill. One point I raised in my written testimony is to hold the agency that manages the Hawaii Violent Death Reporting System accountable for their decisions and actions.

The Center for Disease and-- the Center for Disease Control and Prevention manages the National Violent Death Reporting System. All the 50 states, District of Columbia, and territory participate in this program, as does Hawaii. To control the quality of the data, there are many rules, regulations, and requirements and standards that each participating system needs to meet.

Anything outside of that, as the Department of Health stated in their testimony, would not be constitute as the Hawaii Violent Death Reporting System as it's designed. And the future plans that the DOH proposed, those are future plans.

In the meantime, data abstraction and collection is on pause, which is detrimental to the data system, such as Hawaii Violent Death Reporting System. Colonel Swanson stated, suicide is the second leading cause of fatal injuries in Hawaii.

The trauma system the DOH has does not collect information on ligature or hanging, which is the most common suicide lethal means in Hawaii. The trauma system does not include the suicides that happen at home. The quality of data matters greatly.

So in addition to safeguarding the quality, accuracy, and continuity of data, holding agencies that manage the Hawaii Violent Death Reporting System to their account to their decisions and actions is essential. And that is why I am supporting this bill. Thank you to the Chairman, the Vice Chair, and the committee members for this opportunity.

Thank you very much. That's all the testifiers I have listed. Anyone else wishing to testify on this bill? Seeing none, members, questions? Chair Marten.

For Mr. Hall, please. So your testimony is very clear in the feeling that you folks already have a system like this, and yet we've heard from our other testifiers that there's some data that might be very important to suicide that you don't collect, like methods, circumstance of death, location, and population risk factors. Is that something that could be added to your system so that we don't have two redundant systems?

Yes, thank you for asking. So we are-- we've issued, and we have a contractor that's integrating every data point that's within the CDC system working in communication with the CDC so that we can integrate ours with theirs where it will electronically <inaudible>. So I just want to clarify.

Every violent death CDC data dictionary data point is being incorporated within the state patient registry system so that we will maintain control of that and can forward the information to the CDC. We did have to issue a contract and hire a contractor to assist us with that, and they're currently doing that work as we speak.

Okay. So I-- that addresses continuity, which I think they brought up, but what I don't know, and maybe you do know, is whether that data includes the things that they mentioned that are not being-- like whether it's an event that happens at home or what? Is it ligature? Those items, are they already available, and if not, can they be added by our state or do we need a separate system in order to capture that?

Do not need a separate system. We can capture that with our current capabilities, and we're implementing that right now.

Thank you. Thank you, Chair.

Okay. If I could follow up with Mr. Hall. How imminent is the work of the contractor? I mean, when will you relaunch the Hawaii system?

Yeah, so there's a couple parts of that, right, that caused us to-- that had the pause. One was, we lost the federal funds, and it was a grant, and so until we could renegotiate the terms. We've reestablished that, but in the interim, we did identify trauma and other specific funds within the Department of Health that allowed us to go out to bid to get this integrated while we were negotiating with the CDC.

So we do plan in the next six months, but ongoing, we do have staff members supplementing, and I got a report from the CDC as of yesterday that we do have over 250 records that were concurrently--that are put in the system--that we're going to maintain in their system while we're building out our current system. So we're working through it.

We don't have the funds to staff those people that are doing the concurrent work until we finish our terms and agreements with the CDC, and we're almost there. It's in the final review of them executing the NOA. Once we get that, we can then put out another bid for contract staff to actually do concurrent abstraction, but our current staff is doing what we can simultaneously while we're doing this work.

Okay. Thank you.

Next bill, if there are no other questions. Next bill we have up is HB 1669, requiring the Department of Health to provide educational materials relating to lung cancer screening. Department of Health.

Good morning, Chair Takayama and Vice Chair Keohokapu-Lee Loy, and Members of the Committee. I'm Lola Irvin, representing the Department of Health. So the Department of Health respectfully opposes HB 1669. We support promoting health and improving quality of life through effective prevention, detection, and management of chronic diseases. So effective is an important word here.

Now, what we do is rely on evidence-based strategies and collaborations to build the systems of care. And we do not find that there's any evidence that using the tobacco retail environment is an appropriate venue for educating people about lung cancer screening. Lung cancer screening is really complex in terms of when people qualify and whether they qualify.

And it really should require a conversation with their healthcare provider, and also that this would be a mandate for tobacco retailers, and we find that this would be unenforceable and it would take away resources that we have from evidence based approaches to help people to quit and also then to work with providers and collaborate on building the systems approach for early lung cancer screening.

So thank you for the opportunity to provide testimony.

Thank you. On Zoom, I believe we have the Attorney General's office. In person.

Good morning, Chair, Vice Chair, Members of the Committee. Blair Goto on behalf of the Department of the Attorney General. Our concern with this bill is the requirement on page three that every retail tobacco seller display government-designated signs at point of sale and distribute written notice on cancer screening to consumers.

Because the signs and the notice do not directly warn consumers about the product itself, compelled speech required by the bill could be subject to challenge under the First Amendment. Accordingly, we are recommending changing the mandatory requirements to voluntary provisions as stated in our written testimony, and I am available for questions. Thank you.

Thank you. All important shall to me. Let's see, we have testimony from the Hawaii Medical Association in support, as well as the American Lung Cancer Screening Initiative. Anyone else wishing to testify? If not, Members' questions? Seeing none. Let's move on.

House Bill 2314, relating to emergency medical services statutes. And first up, we have, let's see, University of Hawaii in support. Hawaii Emergency Management Agency in support. Department of Health.

Thank you, Chair, Vice Chair, Committee Members. Garrett Hall, Chief of Emergency Medical Services. We stand on our written testimony and are in strong support of this measure introduced as part of the Governor's package. We also recognize the University of Hawaii's comments and would like to provide some additional clarification.

This modernization brings us up to state with brings our state into compliance with national standards. Currently, the licensing department within the Department of Health is licensing advanced EMTs. We have 38 licensed in the state. However, our EMS statutes do not allow for us to write protocols or guidelines for those individuals that are getting licensed. So we do need that part.

It does not mandate that we implement an advanced EMT program in the state. So we just want that to be clear. However, we do support the university and believe through rural healthcare transformation and the need for workforce development that advance emergency EMTs is something that we should pursue with the university and potentially need additional funding for them to implement those programs in the future. Mahalo and thank you. Open to questions.

Thank you, Mr. Hall. Let's see. Hawaii State, Hawaii Health Planning and Development Agency. Dr. Jack Lewin.

Good morning, Chair, Vice Chair, and Members again. SHPDA sits on the Emergency Medical Services Advisory Council. We believe this is extremely important for us to modernize our systems throughout the whole spectrum of emergency care. We strongly support it.

And I might just add as a matter of personal request is that I have to... I have another conflict. We also support the air ambulance bill that will be coming up in a few minutes. We didn't submit testimony, but that's also very much needed. Thank you very much.

Okay, let's see. We have testimony in support from the Oahu EMS Branch, as well as Office of Hawaiian Affairs and Kauai County EMS. Anyone else wishing to testify on this bill, HB 2314? Seeing none. Members, questions?

Karen Boyer on behalf of the University of Hawaii System. We stand on our written testimony with comments.

Okay, thank you. Oh, I thought I called UH. Sorry. There being no questions. Let's move...

I guess I... Sorry, I have a question for UH. So it seems like your testimony is affecting you. Who is responding to... I don't know if it's for a different bill, but this is just updating the, you know, language. It's a no money bill. And so how is, was there some confusion? Were you looking at implementing and upgrading the system?

Yes, yes. Based on the other bill, SB 3134, that provided for provisions for the EMTA license, we anticipated that we would need to provide that education to the existing community to create EMT education and practice ability.

Thank you. Representative Amato.

Thank you. Question for UH. Thank you for being here to testify today. I'm curious, since the need is greater on the neighbor islands, is there any effort in place to expand this program to our neighbor island system?

The EMTA program? Our state wasn't recognizing the licensure or something changed. And I can't speak to that. I haven't been in my position that long. But we could do that. We could provide that education. We would need to expand our lectures, so training facilities, and this bill allows us to consider that.

Thank you. Thank you, Chair.

Sorry, I should have asked you earlier. Could you identify yourself by name and title?

I'm Karen Boyer. I'm Dean for the Health Academic Programs at Kapiʻolani Community College, on behalf of Lui Hokoana, Interim Vice President for Community Colleges, University of Hawaii System.

Okay, thank you very much.

I don't see any other questions. So let's move on to HB 2372, authorizing registered nurses and qualified paramedics to administer medication as part of an assisted community treatment order. First up, Attorney General's office.

Here.

Of course.

Thank you. Good morning, Chair. Vice Chair, Committee Members. Ian Tsuda with the Department of the Attorney General providing comments. The department believes this bill can be interpreted in a manner inconsistent with procedures for assisted community treatment, which prioritizes reasonable efforts to solicit voluntary compliance before emergency or involuntary procedures are involved.

To address this, we recommend certain language that the Administration of Medication in the community is done with the consent. Thank you for your time. I'm available for questions.

Thank you. Hawai'i State Department of Health.

Morning, Chair, Vice Chair, Members of the Committee. My name is Gavin Takenaka. I'm the Adult Mental Health Division Administrator here on behalf of the Department. The Department stands on its written testimony providing comments. Here we have today, in case there's questions, Dr. Koyanagi, our expert on ACT orders. Dr. Tori Ikehara for any questions on nursing. And Chief hall is here for a minute. Thank you.

Just for the record, I would note, Doctor, that you're asking in your testimony for basically a more clear definition of paramedics. Correct. Okay, thank you. Thank you. See James Ireland, City and County of Honolulu Emergency Services Department.

Chair, Members. James Ireland, Director, Honolulu Emergency Services Department. We stand by our written testimony in support of. I just wanted to just give you a couple real world examples. For instance, about a week or so ago, we had a patient under act, act order, didn't want to get his shot.

He had to be detained by the Honolulu Police Department. Nurse practitioner from IHS applied from last year Act 219 and MH3 to bring him to the Queen's Medical center where he. They waited for a physician to see him. He got his shot and then he was released back to the community. So that was.

That's how the process works. Now, CORE had an injury who was a danger to himself. Recently, we found he also was due for his shot. So again, he was detained under the MH3 through the CORE program and a licensed provider, HPD, took him to Queens again and he got his shot.

So this would alleviate that necessary step of going to the hospital, especially if you're not in the downtown area, maybe Waianae or North Shore. It might be a lot easier to do this in the back of the ambulance.

My only comment would be under the current MH3 rules, the destination has to be approved by the Director of Health. So for instance, the Behavioral Crisis center in Evely, or maybe like Castle ER, Queens ER.

And I'm not sure if we could detain somebody under an MH3 order and then give them the shot and then release them from the MH3. So that would be my only concern. We support the bill.

Okay, thank you. Mr. On Zoom. Hawaii Disability Rights Center.

Yes, good morning. Thank you, Chair Takayama.

I'm Lou Erteschik, Director of the center. Well, yes, the Attorney General is correct. I totally interpreted it the other way because that is kind of how the Bill reads. As I indicated my testimony, it's not so much whether a nurse or an ambulance driver is capable of giving an injection. I don't have any issue with that.

But under the law, under the current law, this has to be done in a hospital under strict medical supervision. And so when the Bill was first introduced, rather when the program was created and over the years, that was always the promise that was made.

So my concern initially with the bill is that the language is so open ended that. Okay, where exactly are we talking about that somebody is going to be taken to give this? So we were opposed to the Bill with the Attorney General's amendment. If the person consents, then I certainly feel better about it.

I mean, if the person is willing to consent to getting the injection somewhere else, I think that's fine. Although I do have the concern that if they don't consent, they're going to get hauled off to the hospital.

So I think we want to take steps to make sure that the consent, real consent and not some sort of illusory consent. I think we need to build in some safeguards. And I'm sympathetic to what Dr. Ireland is saying, but this is not supposed to be for the convenience of the ambulance driver.

This is supposed to be for the protection of the patient. And so I think the current law is fine. But if somebody, if the patient wants to consent to get the injection in another setting, I think that would be okay, as long as we're sure that it's a genuine consent.

Okay. Thank you very much for your testimony. Let's see. On Zoom, I believe we have Angelo Young not present. They're not present here. Jim Gottstein in opposition. Let's see. We have written testimony from the Institute for Human Services. IHS in opposition. Anyone I missed wishing to testify on this bill? Yes. Please step forward.

Good morning, Doctor. Good morning. I hadn't anticipated saying anything, but when I saw Dr. Island stand up here, I want you all to know that he saved my life.

Would you tell us who you are, please?

My name is Robert Pickering. I live here half time and in Phoenix.

I was doing an ocean swim for Dukefest 13 years ago. I was out about 3/4 of a mile and I had a cardiac arrest. And the reason I didn't drown is because when you have a cardiac arrest, your heart stops. Therefore water can't or seawater can't get into your lungs.

On that day, I believe one of the very first times there was an ambulance, Kappakaua beach boys got my heart going. They wheeled me right out to the street into an ambulance to Straub Hospital. About 70 minutes later, I was coming out of the operating room with a stent and here I am.

Today, timing is critical to save lives. And I think I'm a pretty good example of that. So thank you, doctor.

Thank you. And thank you, Mr. Pickering, for being here in every sense.

Chair, Vice Chair Committee Members Carrie Ann Shirota. I'm a community Member and I'm here to raise concerns. They've been ongoing concern about the Assisted Community Treatment Order. As you know, I previously worked for the ACLU.

I as the policy Director, I'm an attorney and we have raised in the past and I will continue to raise concerns in my personal capacity that the fact that we do not guarantee individuals the right to legal counsel in a family court hearing relating to Assisted Community Treatment Order is unconstitutional.

Not only is that my opinion or the opinion of the ACLU previously, but the Attorney General's office some years ago also raised constitutional concerns. And just because we've since passed the law doesn't mean that we should just move on. A violation is a violation.

And I know all of you are here because you care about our community, but you also take an oath to uphold the Constitution. So I ask that you consider that. The second point I want to make is that I'm very concerned about the expansion of who who is able to administer psychotropic medications.

There are some individuals who go to school and specialize 12 years fellowships, but we are expanding individuals who can literally forcibly inject people on the street who may not have capacity or may have capacity in that moment that they don't want to take that medication. Maybe there's severe side effects, there could be complications.

To what extent are we going to allow a number of health professionals who are not trained to do enforced injectables? And with this idea of consent, what is truly consent?

Because if you're having police coming into a place and they are armed officers, does that person really feel like they have the ability to make a decision about their bodily autonomy, the right to liberty? And so I humbly ask that you carefully consider this measure.

I think there are not enough safeguards in place and we need to rectify the fact that if individuals have due process in a family court proceeding and they're entitled to legal counsel like almost every other jurisdiction in the US and in California, an individual is entitled to guaranteed legal counsel at every step of that process.

Until we do that, I ask that you oppose this measure. Thank you.

Thank you very much. Anyone else wishing to testify, if not Members, questions. Representative Marten, followed by representative Tuc.

ker for Dr. Ireland, please. So. So as we heard, seemed unrelated to this Bill, but did make the point that being in close proximity is very helpful. I personally do defer to our healthcare providers over our lawyers when it comes to mental health care.

And so I'm very much in support of ACT and feel that we very underutilize it in our state. And just for those who might not know, what we're discussing today is not a decision about whether to administer the treatment or not. It's just that decision has already been made through the court system with trained medical professionals.

This is just about, you know, providing the medicine that has already been court ordered. And so my question to you is, if this Bill were amended as proposed by the Attorney General, that the subject has consent at that time for that particular injection, would that be helpful?

Would that change anything and allow the core team that's already doing medical outreach on the street with our homeless population, would it allow them to treat more people?

Or is it always the case that it's that patients object and they need to be go through the police, et cetera, et cetera, and be taken to the emergency room to be injected and then released?

Thank you. Just to clarify, if someone is going to. This is. You're right. This is a court ordered process. The legal process has already happened and now they're subject to this order. If someone will take the shot voluntarily, I don't think there's any issue. Cor is not involved. Whoever their case manager is provides that shot for them.

It might. And it can be really anywhere, wherever they're living in a homeless shelter. So I really don't think if it's voluntary, this applies. This is for someone who skips their shot or is not completely complying with the court order and then has to be basically forced to take the shot.

So I think that's what we're talking about here, requires a detainment and, you know, with respect, it doesn't inconvenience the paramedics because generally this is handled by the Police Department who transports to the emergency room, gets the shot and then releases the patient. So we're actually not involved in this on a regular basis.

But it's just we were involved last week because we happened to be detaining somebody under an MH3 because they were a danger to themselves and just found out coincidentally they had missed their shot and needed it.

So that patient was transported by court to Queen's Medical center where their provider case manager met them and gave them the shot. But I think again, this, I think just applies to those who are not following the court order, which has already gone through. But again, if they are getting this voluntarily, we wouldn't even really be involved.

As a follow up, when you say that that person was a danger to themselves, if they had had their shot, would they have likely been a danger to themselves or they had been.

Okay, hard to say.

Thank you. Chair.

I have a question for Department. Of Health and the testimony you provided, please. Or maybe for Dr. Kinog, it's kind of a process question, I guess. Thank you for the robust testimony kind of outlining things like, you know, creating the medical treatment teams for care because, you know, as ACLU and others have pointed out. Sorry, doctor.

For Department of Health, you know, we under the ACT program, we do kind of put together these medical teams because as ACLU and other support, we don't want to necessarily take people's rights away. We're trying to give treatment. And then so, you know, including making sure all the points you guys made about the appropriate scope of practice.

So to the point that you guys kind of shared about the mobile pharmacist, does that is this maybe just a process thing that we're trying to do? And should the mobile pharmacist just be kind of rolled into the process a little bit more, more to kind of address the concerns you guys raised about who's administering and where?

Would that be more appropriate and be a way to help kind of bridge some of these gaps that I think. Is the concerns of the Bill.

Chad Claynaly, Department of Health so what we're trying to paint a picture of in the testimony is that ACT is a very specific, intensive law that allows people with severe mental illness to proven court to meet the criteria of act.

And it is the expectation of the court and the treatment program that they have a well integrated, coordinated system whereby folks can be continued to be offered psychiatric care and case management and offered opportunities to make choices when possible.

Mobile pharmacy is a tool that is often used by some of the case management agencies that administer ACT orders. They're well trained people who are well versed in psychiatric medication side effects, positive effects. For example, with IHS. They have a close relationship with 5 Minute Pharmacy and have some of the Patients who are on ACT orders be.

Given. Their shots by mobile pharmacists in conjunction with coordination of the behavioral health team. Other instances that psychiatrists will go out into the field and attempt to offer the shot in a voluntary way, non coercive way.

When things play out, of course, in the days leading up to the time when the shot has to be given up, given to the patient, there's lots of opportunities for ongoing efforts to engage the patient, convince them to stay on their medication.

When the day plays out where the team goes out and has to think of all the options to. All the.

Ways that things may transpire that day, it's important that the prescriber be involved with the interaction with the patient and or the mobile pharmacist who is working as part of the treatment team be allowed to engage the patient.

They may have to address patients concerns about side effects, maybe actual side effects that need to be addressed and alternative medications may be considered.

So because of all these complex moving parts, that is, it's helpful that the team itself and or additional team partners like 5 Minute Pharmacy or mobile pharmacist can work with the team to address that delicate situation with lots of complexities. I'm sorry, it was complex.

Yeah, no, I know. It's a complex program. So, okay. Because then if we.

Okay.

I think that answers my question. Okay, thank you. Thank you, Chair.

Okay, thank you. Any other questions? Representative.

You can stay, Dr. Koyanagi. Thank you. Okay, so I'm trying to understand the need for this bill. And based on what you just shared, and from what I've heard from other testimony, it sounds like this population that this bill is supposed to benefit, they've already been court ordered to involuntarily get medication through the process that was described.

So from what I'm understanding, it's, we know that they're taking medication. And at some point it gets to where they're not taking their medication and they become a danger either to themselves or to others. And so emergency responders appear on the scene. Typically, from what I understand, it's going to be police officers. Am I kind of following it?

In an ideal world, in most of the circumstances, it's the treatment team that should be there first. The first responders only arrive in certain circumstances. Like the individual mentioned that IHS was having a very difficult time trying to find, bouncing all over the community. And so in an ideal world, the team should be planning engagement in the community, and having first responders respond should be the exception rather than the norm.

Okay, I follow that. So I'm assuming that this law is necessary because we don't live in an ideal world and we do end up in situations where they need to take medication without consent. But from what I'm getting is the concern is where it's going to be administered and how quickly. Because currently what's required is they be taken to an approved facility. Right? And so I'm hearing the concern by the AGs, it's, well, where are they going to be admitted? Where will the medication be administered in the community?

And so I'm confused as to why can't we, what's wrong with the current? Is it just because it's not as urgent and timely? Because if a nurse is not already with the police responding, it's going to take time for them to get to the scene. So, you know, I'm just, I'm just, I truly want to understand the benefit of this and weighing the rights of the patient as well.

So current law basically says that providers in the field cannot administer medication when patients are not voluntarily complying. They have to go to emergency room or hospital. And that's many reasons, including safety, patient privacy. I don't think you want to have people getting held down on the sidewalk to get shots involuntarily. It's not a good look.

Okay, so it sounds like it's just so they can stabilize a patient versus taking them to the hospital.

So, for the most part, yes, There are times when people are overdue for their ACT orders. And the other part of the law requires if the person is uncooperative with taking a shot in the community and has come into the attention of first responders, then they probably should be taken to an emergency room. And the other part of the law is that the healthcare facility is required to determine whether the person on the ACT order is also deemed appropriate for involuntary psychiatric hospitalization.

Okay, thank you.

Thank you. Any other...

Dr. Koyanagi, thank you for being here. So, you know, I feel like there's some overlap between the state programs and the city programs to try to address our shared problem with a lot of pretty serious mental health, people suffering from mental health problems that are living on our streets. And what I'm hearing from you is that you have a team that goes out and tries to, even though these are court ordered treatments, try to work with the patient to get voluntary consent for a particular dose.

Do you feel like the CORE team, which is also out on the street and are also medical professionals that do have an ambulance with them, so it would not be holding down someone on the sidewalk? I mean, do they fit in this puzzle as part of the outreach healthcare team, or do you view them as irrelevant to our state's goals of getting these people on treatment?

I think the current behavioral health case management teams are doing the best they can to work with ACT patients and in recent years, trying to understand the confusion or ambiguity regarding the law as far as involuntary transport. I think if a need came up in the future, the case management agency would ask for it.

But I believe the court makes them responsible for providing all aspects of the care related to the ACT order, and that includes engaging the patient, giving them choices, and if necessary, providing them involuntary medications consistent with current laws.

So I would take that to mean that no, you do not see a role for the CORE program.

I don't think the current agencies have... I've never heard of an agency asking for an additional component of the treatment team.

Maybe if I could follow up on that. Seems like the nut of the issue is whether someone who is the subject of an ACT order needs to be taken to a hospital medical setting or whether whatever medication is involved can be administered by paramedics or in an ambulance. And you're saying that's not a good idea?

Like Dr. Ireland said, if the patient is willing to take medication voluntarily in the community, either the team assigned to take care of that patient can give it...

That's not what this bill says though. The bill doesn't say voluntarily.

Then, again, the current... I mean, current law specifies that patients on ACT orders need to be taken to ER or acute care hospital for shots.

And an ambulance is not an appropriate setting?

It's not. An ambulance is not a emergency room or a hospital.

Okay. All right, thank you very much.

But just one last question. If that patient consented, you could give that same medication just on the street, not even in an ambulance. But somehow lacking consent means the same patient with the same medication suddenly needs our emergency rooms.

Sorry, repeat the question.

If that patient had consented, your team could give that same medication on the street? But lack of consent means they need to have an emergency room setting instead?

A person who was cooperative with taking a shot could be given that shot in the community.

Okay, thank you.

No other questions. Let's move on to the next bill.

Thank you, Chair. The time note is 10:26. I'm going to assume role of the Chair. Moving on to House Bill 2508, establishing a statewide air medical service program within the Department of Health. Members, we have Department of Health in support.

Chair, Vice Chair, Committee Members. Garrett Hall, State Chief of Emergency Medical Services and Injury Prevention. We stand on our written testimony in support of the Senate Current Resolution 86 Working Group and this measure.

Thank you. Members, on Zoom we have AlohaCare. Not present. Members, we also have in support of State Department of Health, Hawaii Emergency Management Agency, Hawaii Medical Association, and one individual. Anyone wishing to testify on House Bill 2508 here in the audience? On Zoom? Members, any questions? Great. Thank you. Moving on, Members.

We are on House Bill 19666 relating to amend the emergency medical service Special Fund by authorizing the deposit of revenues from billable emergency medical services. Department of Health in support.

Madam Vice Chair Committee Members, thank you for the opportunity to submit we stand on our written testimony but would also like to add a point of clarification. So thank you for the opportunity to provide this testimony in support of House Bill 1966, the proposed procurement exemption within the EMS Medical Services Special Fund.

We would like to stand on our written testimony and the additional verbal com comments as this measure is written to prevent delays in life savings life saving care that needs to be provided each day across the state. Running the statewide Emergency Medical Services 911 system is very different than operating normal state operations each day.

It's focused on providing life safe, life, timely, efficient, effective, equitable, patient centered care. We would first like to respectfully acknowledge and appreciate the procurement office Administrator and their comments on transparency, accountability and guidance. We share those values and ensure fair processes and preventing favoritism, collusion, fraud.

It is important to note that we have submitted this comments on this measure and it's been proven within the Department of Health through the State Trauma System Fund. Over the last 20 years EMS the trauma system Fund has operated with a procurement exemption.

During that time the Fund has allowed and demonstrated administrative oversight, transparency and physical measures with no fraud, waste or abuse. That flexibility allowed the state Trauma system to develop where Queen's became a Level one Trauma center.

All of our Level three center all of our Level three centers are ACS verified and we could quickly provide the equipment and life saving care that they needed. That same is not extended to our Emergency Medical Services Special Fund. We have missed out on opportunities where ambulances could not be provided timely.

Currently we have a stroke program going across the state that's been a pilot where we're not able to quit quickly expand that program that's proven to save lives. You can't purchase AEDs or other items on bulk quantities which save lives due to issues with the procurement process and time limits.

So we do respectfully acknowledge that that is a valid concern. But we've been doing it for the past 20 years with the Trauma System but with no violations.

So mahalo on Zoom Tom Yamachika Tax by Foundation.

Aloha Colleen Teramae For Tom Yamachika the Tax foundation of Hawaii stands on its written testimony.

Thank you, thank you and Department of Health in support ok anyone in the audience wishing to testify. Any Members on Zoom please proceed.

Hello, my name is Laura Mallory Sayer and I am speaking to you as a community Member but also as an Executive Director of the Daniel R. Sayre Memorial Foundation. Our mission is lives in Hawaii and we concur with false testimony.

The procurement process when it comes to emergency supplies is it's onerous and it can take up to two years to purchase equipment that could be saving lives today. Oftentimes the procurement process doesn't even provide our EMS services with the best equipment available with the best technology available.

And by the time we get it ordered through the procurement process, the cost of purchasing those items has escalated. We which limits the amount of equipment that we can actually buy. I know this for a fact after serving for 28 years in purchasing emergency medical equipment for our first responders.

So I would urge you to support this Bill and to please allow the Department of Health not to have to go through the procurement process. I understand the valid reasons for having a procurement process in the state and the county. But this is going to be an enormous roadblock for our future. So mahalo for your time. Thank you.

Thank you. Ms. Sayer, good to see you.

Good to see you.

All right. Thank you. Members, any questions? Great. With our chair back, I'll turn it back over to him.

Thank you. My chair. Let's see. Last two bills on each. And the first up is each the 2558 relating to telehealth. Expanding Telehealth services to certain. For certain medical treatments out of state.

First up, we have University of Hawaii.

Good morning, Chair, Vice Chair, and Members of the Committee. My name is Christine Beaule. I'm the UH System Director of Workforce Development. We stand on our written testimony, and I am available to answer any questions.

Thank you. DCCA.

First we apologize for the late testimony. We have a brand new last coordinator. There was some mix up. So thank you for taking in our testimony. We submit some concerns relating to this bill, so I'm available for questions.

Thank you. HMSA.

Good morning, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and Members of the Committee. I'm... with HMSA. Thank you for the opportunity to provide comments on House Bill 2258. HMSA has long supported telehealth is an important tool to expand access to care, especially those living on our neighbor islands and in our...

However, as access is expanded, it is critical that patient safety, quality, and accountability remain intact. Our concern really is that by allowing out of state providers to provide treatment to patients in Hawaii without having a Hawaii medical license permits them to function under their own home state's licensure requirements, which differ than Hawaiis, including scope of practice, prescribing rights, overall quality oversight.

And so I'd also like to point out actually additionally that in the bill there's language that states that this shall only apply to services with physician shortages or lack of reasonable access, which is very broad and undefined and could cause some confusion and overall inconsistent application. So thank you for your time this morning. I'm available for questions.

Thank you. Let's see. We have AlohaCare offering support. On Zoom, Hawaii Islands Republican Women, Jamie Detwiler.

Aloha, Chair. Can you hear me?

Yes, we can.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and Members of the Committee. Jamie Detwiler, Hawaiian Islands Republican Women, testifying in strong support of HB 2558 for the following reasons. Allowing Hawaii residents to access telehealth care from qualifying out of state providers could help address healthcare access and staffing shortages, especially in rural and underserved areas.

Specialty care providers are highly sought after, which often leads to longer wait times and and postponed treatment. I'd like to also bring in a personal note. I know of two family members who reside on Hawaii Island where it is even harder to access specialty care. And they have experienced postponed or delayed treatment. And so for these reasons, Chair, Vice Chair, and Members of the Committee, please vote yes on HB 2558. Mahalo for the opportunity to testify.

Thank you. See we have a Hawaii Health. Oh, I'm sorry. Healthcare Association of Hawaii, Paige Choy offering comments. Hawaii Association of Professional Nurses in opposition. Grassroots Institute of Hawaii in support. Hawaii Medical Association offering comments. Written testimony from 14 individuals in support and one in opposition. Anyone else wanting to testify on this bill?

Aloha, Chair, Vice Chair, Committee Members. Carrie Ann Shirota. I am living in Honolulu but was raised in Kahakuloa on the island of Maui, which is a very rural area. And I can speak that my family members consistently have difficulties accessing care.

Constant turnover of PCPs, lack of access to specialists. Sometimes they're able to travel here to Oahu, but other times that has not been possible. And I can just share with you, even though I have not... I looked at the bill quickly. I would need more time to vet it.

I would really like to see that this concept further explored because of the fact there is a critical shortage. And I'll give you two examples. About two and a half years ago, my loved one was diagnosed with a rare cancer. Very few oncologists here were familiar with it.

Despite severe pain, the person was going through, I had to literally, we had to fly up to California, to the city of Hope, pushing him in a wheelchair to be seen for a consultation because we did not allow for telehealth. We literally needed to find the resources to get up there.

And it was, it was, it was just so difficult to see this person already suffering to put him on a plane who had lesions on his spinal cord. If we allow for the specialist to work, that could have possibly alleviated or reduced the number of times for a bone marrow transplant surgery further down the line.

Currently I have another family member who lives on Maui, and she has been diagnosed with a rare condition. And we literally this week I have been calling UCLA, Stanford, other specialists to see if we can get additional care or second opinion. And a number of these places allow for second opinion, sometimes a written second opinion.

But they will take a look at the state if they don't have a doctor who's dual license in Hawaii and California, they're saying we can't see your sister. Probably shouldn't have said that. See a family member by telehealth because we're afraid that we're going to be charged with unauthorized practice of medicine. But this is a serious condition, and I just humbly ask that you think about people in the neighbor islands for all of us who need a specialist. Thank you.

Thank you. Anyone else wishing to testify? If not, Members, questions? I have a question for DCCA. I read your testimony to say that you have concerns about out of state physicians practically practicing medicine via telehealth.

And that this would limit, number one, knowing what their qualifications are and you are being able to know whether they have any background negativity in the records. Would it alleviate state's concerns if we made it clear that the telehealth practitioner must be under the supervision of an in state physician here in Hawaii?

Yes. Where we are processing application, at least 30% has convictions or or disciplinary which the action relate to malpractice. So how I make good more and then we work together to appropriate suspension for any kind of filing of action.

But when we just allow out of state physician come to here without any types of license here, Hawaii has no jurisdiction to control them. So we only think about only good doctors come here, but always there's some bad ones come together. So when some accident, incident, malpractice happens, when they disappear and it's total patients and get more harm from that.

Okay, thank you, thank you very much. There being no other questions, let's move on to the final bill on the agenda, House Bill 1898, regarding immunization. First up we have.

Let's see.

The attorney. Deputy Attorney General.

Good morning Chair, Vice Chair and Members of the Committee. My name is Kaena Keao and I am here on behalf of the Department of the Attorney General to provide the following comments on possible points of confusion with implementation of this bill. We note that Department is not defined as Department of Health.

We also note that the bill changes prevailing medical standards plural to prevailing medical standards singular. And we also note that it uses a clear and convincing evidentiary standard which is a legal standard that's not easily translated into a non legal setting.

As such, we provided recommendations prescribed in our written testimony to avoid any possible confusion when implementing the bill. I am available for any questions. Thank you for the opportunity to provide comments.

Thank you. Department of Health.

Aloha Chair, Vice Chair, Community Members, Kenny Fink with the Department of Health providing comments. We very much appreciate the intent of this bill that seeks to address a very important public health issue.

Under the Patient Protection and Affordable Care Act, HAPP plans were required to cover evidence based preventive services recommended by the Advisory Committee on Immunization Practices and the US Preventive Services Task Force. In the past year there have been changes that have negatively impacted that.

The US Preventive Services Task Force has not met since March of last year and for the ACIP after its membership was replaced, it has stopped following a process by which it looks at the full body of evidence in a systematic and transparent way and it has not adopted an evidence recommendation framework that has resulted in a divergence of its recommendations from those of the American Academy of Pediatrics.

Those two different sets of recommendations or standards are in conflict and as was raised, having one set standard of both creates confusion to providers and to patients and perhaps to the coverage. So we acknowledge those remarks.

We also feel that it is important to have one single set of recommendations for clarity for patients and providers and to ensure coverage without cost sharing. For such recommendations, ensure access to care is a priority and to follow the intent of what was initially passed to allow coverage these important preventive services.

So rather than having a federally mandated process, we are proposing have a state based process that a provider led. So there is a single set of recommendations for the state that health plans would cover again to follow the intent of the essential benefit services.

In addition, the goal is to ensure access for those who choose to receive these preventive services. So ensuring that pharmacists can continue to provide such recommendations is important as that may be the access to care for many people, particularly in rural areas. In addition, we want to protect providers who are following these recommendations from a local group.

So with respect to the introduce of the bill, we hope that these receive as friendly amendments to advance the intent of the measure and we do offer amendments for your consideration.

Thank you. See DCCA.

Good morning, Chair, Vice Chair, Members of the Committee. Justin Chu for the DCCA's Insurance Division. We stand on our written testimony providing comments and available for questions.

Okay. HMSA.

Chair, Vice Chair, Members of the Committee. HMSA HMSA recognizes the challenges and uncertainty created by the constantly shifting federal landscape regarding healthcare policy.

As a healthcare organization, our commitment to our Members and the state has led us to expand our immunization policies to improve recommendations beyond the ACIP, including but not limited to guidance from the Department of Health and the American Academy of Pediatrics.

I think our comments largely surrounded by the fact that we're not certain how conflicting guidance from the two organizations listed. Within the bill can both be presumed. To be the standard by the Department.

We highly agree with Department of Health that vaccinations improve health outcomes and want to ensure that individuals who choose to be vaccinated continue to have reliable access to coverage. Thank you for the opportunity to testify.

Thank you. See we have written comments in well written comments from the Hawaii Medical Association, Healthcare association of Hawaii, comments from PEP Free Hawaii and written testimony from two individuals in support and two opposed anyone else wishing to testify on HB 1898. Members, any questions? Representative.

Thank you, Chair. For DCCA Agents, I'm reading here in your testimony on I think it's on page one, it says the Department. Notes that it is unclear whether the. Amendments of Section 2 through 4 of. The bill would trigger the frail requirements under 45 Code of Federal Regulations. Would you please elaborate on that?

Sure. I guess I'll start from the top, which is that under the Affordable Care act, every insurance plan sold in the state is required to meet or exceed what's called the Essential Health Benefits Plan, and because these plans are subsidized, can be subsidized on the federal exchange.

If a state mandates benefits that go beyond that, the state is required to defray the cost of those benefits for those plans sold on the exchange. So as part of that, part of the Essential Health Benefits plan are required to cover recommendations by the HCFP Advisory Committee.

So if you know granting these powers to the Department of Health, if the Department of Health decides to mandate immunizations that are not currently covered in the Essential Health Benefits plan are not currently recommended by ACIP, which something possibly could be the case and the state might be on the hook for deferring those costs. Got it.

Thank you.

Any other questions for members? If not, let's move on to decision making. Thank you all the, thank you to all the testifiers for taking time to let us hear from you. We would appreciate it. First up, we have House Bill 1871 establishing health monitoring pilot program.

I'd like to suggest we move this forward as a House draft, making a couple of amendments on page two of the bill, lines nine and ten. We want to make it clear that people covered in this bill are both nurses and dietitians who are licensed in Hawaii.

Secondly, that since there's no end date for this bill, we want to make it clear that. Sorry, bear with me. So put in language on page four, subsection F that says the pilot program shall conclude two years after the pilot program becomes operational or no later than December 27, 1929 whichever occurs first.

Also, we'd like to remove the $600,000 that's mentioned in the bill and move that to report language. Also make some technical amendments for clarification and consistency and style and also add. Members, any questions, comments, or concerns? Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 1871. Chair's recommendation is to pass with amendments. [ROLL CALL] Thank you, Members. Chair, your recommendation is adopted.

Thank you. HB 1977 mobile app. I'd like to move this forward with a couple amendments. First of all, there's a blank starting date on page one. We'll put in January 12027 as a start date.

Secondly, making it clear that under the rules section of the Bill that the Department of Health shall determine the number of participants in the program. Third is require a report to the 2029 Legislature filling in that link as well. Fourth, blanking out the $150,000 and moving that to report language also defecting the date and other technical questions.

Comments concerns. Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 19767 chair's recommendation is to pass with amendments noting all Members present. Any Members voting with reservations. Any Members voting no Chair, your recommendation is adopted.

Thank you. Next Bill is HB 1878 relating to Eagle Death to 1858. Yeah, is that what I said?

I thought I heard 70 fic.

I'm sorry. I'll articulate more clearly HB 1858 relating to fetal deaths. I'd like to move this forward as a House draft. Noting that on page six of the Bill we would like to replace the existing lines 4 through 15 and this relates to certificates for fetal deaths for miscarriages less than 20 weeks gestation.

Replace it with language that was suggested by the Department of Health as well as Dr. Vink and other OBGYNs. And I will read that section.

It will say that the attending physician, physician assistant, advanced practice, registered nurse or coroner's physician who certified the fetal death use to miscarriage shall issue documentation of fetal death to a birthing parent who experienced a miscarriage upon request of the parent and it goes on.

I won't read it all, but it makes clear what the statement and certificate shall consist of. Another explanation of documentation that is required. So also like to add a defective date and other technical amendments for style and consistency. Members, any questions? If not Vice Chair.

Thank you, Chair. Members voting on House Bill 1858. Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservations. Any Members voting no.

No vote.

Thank you, Mr. Alcos. Thank you, Mr. Garcia. Chair, your recommendation is adopted.

Thank you. Next Bill is HB 1591 relating to a preceptor tax credit. Like to adopt the amendments suggesting suggested by DOE Tax mostly making clear a couple definitions as well as other suggestions. I'd like to add registered dietitians as being Eligible for the tax credit. This is consistent with what we passed in the House Bill last session.

Also like to add technical amendments as well as defective date. Questions, Comments? If not, please. Chair.

Thank you, Chair. Members voting on House Bill 1591. Chair's recommendation is to pass amendments noting all Members present. Any Members with reservations. Any Members voting? No. Thank you, Chair. Your recommendation is adopted.

Thank you. Next. Bill 15, HB 1574 relating to the loan repayment program for healthcare education. I'd like to move this forward as a household. Draft on page four. Adding dentists to the definition of healthcare professionals. Also looking a defective date and technical amendments. Questions? Comments, Concerns, if not Vice Chair.

Thank you, Chair. Members voting on House Bill 1574. Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservations. Any Members voting? No, Chair, your recommendation is adopted.

Thank you. HB 1575 relating to Parkinson's patient Air Transport Committee. I can move this forward as a House draft. I. I think the Bill needs further work, but we want to keep the Bill alive and move it on to the next Committee. Like to remove the $100,000 from the Bill and move that to report language.

Also effective date and technical questions Comments, concerns. Vice chair for the board.

Thank you, Chair. Members, House Bill 1575, chair's recommendation is passed with amendments noting all Members present. Any Members with reservation. Any Members voting? No. Chair, your recommendation is adopted.

Thank you. HB 1854 relating to community behavior. Health clinics. Like to make move this forward with a couple amendments on page two and three. Make it clear that the DoH certification process must meet the standards of the US Substance Abuse and Mental Health Services Administration, also known as samhsa. Delete a section that would create a special Fund.

Delete the $800,000 from the measure and put that in the report language. Also adopt the DoH amendment on page 5, line 10. Changing the language from populated island to populated county also effectively and other technical amendments, I think. Okay. Questions, Comments, concerns?

Would changing it to county mean that in another place you have to decrease the Members from 11 to 9?

Zero, yeah, I'm sorry. And. And further amendment making commensurate correction in the number of Members on the. Committee. Okay, Vice Chair.

Thank you, Chair. Members voting on House Bill 1854. Chair's recommendation is to pass with amendments noting all Members present. Any with reservation. Any voting? No, Chair, your recommendation is adopted.

Okay. HB 1855 by violent death reporting. We had much discussion on this. Like to encourage colonel Swanson to work with the Department of Health and it's implementing an upgrade of the violent death reporting system for us in Hawaii. I think the Bill is current. Testifiers is probably not needed at this time. Consider it in the future.

For now, we'll defer the HB 1669 relating to Lung cancer screening. Also like to note the concerns expressed by the Attorney General and the Department of Health. So Defer this Bill. HB 2314 relating to emergency medical systems of care.

I'd like to move this forward as a House draft on page six with a couple amendments on page six. Sorry, bear with me.

On page six online, beginning on line eight through 12, change emergency medical services personnel language to say that EMS personnel means any healthcare worker who is certified to provide emergency services and substitute that for the language in those lines. Also conforming amendments for consistency, clarity and style, as well as a defective date. Thank you, Members. Any other.

Any questions? Concerns if not Vice Chair?

Thank you, Chair. Members voting on House Bill 2314. Chair's recommendation is to pass with amendments noting all Members present. Present. Any Members voting with reservation. Any Members voting no. Chair, your recommendation is adopted.

Thank you. HB 2372 relating to assistance community treatment. We've had lots of discussion on this measure. You know, it's a work in progress. I'd like to move this forward. I'll adopt the language suggested by the Attorney General. Which makes it clear that nurses and other personnel.

Subject may, with the consent of the subject of the order, administer appropriate medication. And that's on page three, first four lines. Again, this is controversial, so I will note in the report language accompanying the Bill and ask the Judiciary Committee to consider whether this provision is required under our hrs.

Also adopt the DoH clarifying language regarding paramedics and also defective date and technical amendments. Also making clear that the new positions that are. I'm sorry, no, that's it. That's it. So any questions, comments, concerns? Representative.

Thank you, Chair. This is a complex question. I'm concerned that based on testimony that consent under duress is not really consent, I'm concerned that in the situation of forceful injection, it may be a violation of due process rights.

And given that I swore an oath to uphold both the US and the state constitutions, specifically the due process rights route, rooted in the 14th Amendment of the U.S. constitution and also enshrined in Article 1, Section 5 of the Hawaii State Constitution, these rights ensure fair, non arbitrary legal and administrative procedures for all individuals.

Given the erosion of due process rights we've seen at the federal level, we have a clear responsibility at the State level to make extra efforts to preserve those rights. In order to uphold my oath of office, I must vote now.

Thank you, Representative Herzfield.

Thank you, Chair. Similarly, I. That's why I had go first because she articulated it much better than I could have. But I'm going to be voting with reservations because I do believe there needs to be further discussions and, you know, see how far this Bill can go.

But a Representative Amado clearly expressed a concern that I have as well. Thank you, Chair.

Thank you. And. zero, go ahead, Representative. Thank you. Sure. Similar concerns. I do believe that this is a fine balance. I mean, the. The problem is clearly seen in our streets and. And communities. So something needs to take place and happen. But the constitutional concerns is there and. And I want to put that on the record.

So I'll be casting a vote in support with reservations. Thank you.

Thank you.

Any other questions? Comments?

I really appreciate that the discussion that was brought up by this Bill and I feel like kind of shone a light on a problem we have in our state with our state and county not working together well to address our, you know, homeless population with severe mental health illness.

And so anyways, I'm not sure where this Bill will go, but I had not realized until this conversation the extent of that lapse in coordination of available services. And so that's something I'd really like to have our state work on.

Thank you. And if I might say as Chair that my purpose behind what I'm recommending is to do is to keep the Bill alive because I'm aware of the sensitive issues involved.

But yet it's an important acts are an important consideration in our community, noting as Representative Garcia, the prevalence of mentally ill homeless in our streets and the need to do something about that. So thank you, Member. Sir. Comments?

Thank you, Chair. Members voting on House Bill 2372. Chair's recommendation is to pass with amendments noting all Members present. Noting reservations from Member Hartsfield and Member Garcia. Any other Members voting with reservation Noting a no vote from Member Amato. Any other Members voting? No, Chair, your recommendation is adopted.

Thank you. HB 2508 relating to your medical services. Like to move this forward as a House draft, making it clear that the new positions created are exempt from Chapter 76. Also technical amendments and defective date. Questions? Comments? Question?

Thank you, Chair. Members voting on House Bill 2508, Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservations. Any Members voting no, Chair, your recommendation is adopted.

Okay. Next Bill is HB 1966 relating to emergency Medical Special Fund. Let me move this forward. There's a House draft with technical amendments as well as the defective date. Questions? Comments? Question?

Thank you, Chair. Members voting on House Bill 1966, Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservation.

Reservations.

Thank you, Mr. Garcia. Any Members voting? No. Chair, your recommendation is adopted.

Thank you. Next Bill HB2550. I'd like to move this forward as a House draft, adding language to require that telehealth services must be supervised by a licensed in state physician.

Also on page nine of the Bill, subsection D on lines 20 to 21, delete that because because it refers to violation of state laws that are really not relevant here. Also added effective date and technical amendments. Questions? Comments? Concerns? Vice Chair.

Thank you, Chair. Members voting on House Bill 2558, Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservation. Any Members voting no Chair, your recommendation is adopted.

Thank you. The final Bill, HB 1898 relating to immunizations. I'm going to. I've received a request from the Chair of the House Consumer Protection Committee.

He has asked me to move this Bill forward, but because he's in current discussions with the Department of Health on possible meeting amendments at this time, we won't make changes that are suggested by the DoH, but we will make a defective date on the Bill. Also note that the Senate has a Bill in progress.

So at this time I'd like to move this forward as a House draft, simply defecting the effective date and note that this Bill is a work in progress that will be worked on in the coming first of the session. Questions? Comments? Concerns? Vice Chair.

Thank you Chair. Members voting on House Bill 1898 chair's recommendation is to pass with amendments noting all Members present, any Members with reservations. Any Members voting no vote.

Thank you, Mr. Garcia. Thank you, Mr. Alos. Chair, your recommendation is adopted.

No vote.

Thank you Members for your patience.

Rejoin.

Sa.