House Standing Committee on Health

Good morning. Welcome everyone to the state capital of Asogi West state capital. It is Friday, March 20th, 9:30 AM, and we are in Conference Room 329 in case you want to make sure you know where we are. And this is the Committee on Health. I'm Gregg Takayama, Chair, happy to chair our proceedings this morning.

And on behalf of all our members, welcome all of you for being here and testifying on some of the important bills we have before us. So without further ado, let's move on to the first bill, which is Senate Bill 847, establishing a pilot program in the county of Kauai to allow qualified psychologists limited authority to prescribe psychotropic medications. First up, we have the State Department of Health offering comments. State Health Planning and Development Agency, SHPDA. Dr. Jack Lewin offering support with conditions.

BCCA Board of Psychology.

Good morning, Chair, Vice Chair, members of the committee. My name is Christopher Fernandez, executive officer for the Board of Psychology. I'm here to stand on the board's testimony supporting the intent. So just as a background, the board has supported these measures in the past in varying forms. And after discussing with the legislative liaison the change that happened in the Senate side, it still feels that the program could still function.

There's a few changes that it feels that it might need to have. So the way they read the bill was that rules would need to be promulgated before the pilot project could take applicants, and obviously, data collection could be good. So the board's requesting one of two amendments: either to set the effective date to 07/01/2028 or extend the duration of the pilot project from three years to five years, allowing at least two years for the promulgation of rules.

The second thing that it was going to ask was that on page five, line 14, number two, they felt that this may be a little bit redundant for, like, a sort of double approval. So to clarify, they just stated that at a minimum, complete an education and training program in clinical psychopharmacology that is designed by the American Psychological Association to prepare licensed psychologists for prescriptive authority and approved by the Board of Psychology. I'm here for any other call or questions if you have.

Thank you very much. Next up, we have written testimony from Mayor Alameda, county of Hong Kong, Hawaii. Also, written testimony in support from Mayor Derek Kawakami from the county of Kauai.

I might mention that just prior to this hearing, I got a phone call from Mayor Kawakami saying he intended to be available on Zoom, but because they are still dealing with consequences of the earlier storm, not to mention that this one, he is unable to join us.

Let's see. On Zoom, Hawaii Psychological Association, Judy Steinman. Ms. Steinman, please proceed.

Yes. I apologize. Can I just, I stand by the testimony that we submitted? I'm having trouble with my camera, so forgive me.

That's okay. We can hear you. We can hear you. Go ahead.

Just one second. One, could you give me a few minutes? Because my headset's not working. Does that matter?

You know, we can hear you perfectly well. If you'd just like to go ahead and read your testimony.

Alright. Well, I was going to stand by my testimony that was submitted regarding the safety of prescribing psychologists. We have been prescribing for close to thirty years now. And so for somebody to say that it is unproven and untested, I don't consider incorporating all of the data that you'll be hearing about today.

The Hawaii Psychological Association stands in support of this bill, and we are looking to partner with those who, you know, would like to see us be able to move forward to help those on Kauai and hopefully to be able to expand this bill to other islands at some point.

So I'm going to defer right now. We have several psychiatrists who have written testimony in support of our bill. We have nurse practitioners who have presented support of the bill and physicians as well.

And so I hope that we're able to start this pilot study at the earliest convenience, because just as Mayor Kawakami is not available to participate today because of the storm, we know that we will have additional stress going on on all of our islands for quite a while and that this is the time to do it.

We are very grateful to you, Chair and Vice Chair and the committee, for considering this and helping us to move this small step forward in a cooperative fashion to be able to bring prescribing psychology where we need it in Hawaii.

Thank you very much. I don't know why I'm saying extra love. Dr. Jacqueline, we had called you earlier, but you've made your way here to see.

Aloha, Chair, Vice Chair, members. Thank you. Jacqueline, CHIPDA. We've been looking carefully at this, and we think the pilot project concept could work. We strongly believe, at CHIPDA, that this should be a team practice between a psychiatrist and a psychologist. That would be the ideal way to go, particularly because there's a significant malpractice risk for the independent psychologist down the road.

There's so many drug interactions here. There's so many potential complications of this, and that would be an excellent way to expand this. There appears to be a willing psychiatrist in Kauai. Although the location that was mentioned in the original bill is not necessarily available, we can still probably work this out. We'll work out the details.

We're not sure if there is a psychologist with the requisite training needed in pharmacology at this point. But, and I do acknowledge the concerns of the medical community, the psychiatrists, and so forth. And I think that team practice would solve that problem and allow us to expand coverage for people. Thank you very much.

On Zoom, Hawaii Medical Association.

Aloha. Can you hear me?

Yes. We can. And see you as well. Thank you.

Alright. Aloha, Chair and committee members. Dr. Elizabeth Ignacio, Maui physician, and chair of Hawaii Medical Association public policy. My physicians are opposed. We feel that integrated solutions are safest and far superior to isolated or fragmented care. We stand on the written testimony and are available for questions. Chair, mahalo.

Thank you. Hawaii Mental Health Coalition, Melissa Pavlicek. You're not Melissa Pavlicek.

Good morning. I'm here to represent the Hawaii Mental Health Coalition. The opposition speaks of the dangers of the bill as if the sky were about to fall upon Hawaii. But the truth is the sky has not fallen. At Tripler, Marine Base Hawaii, Schofield, the rest of the US Department of Defense.

The Indian Health Service has been doing this for decades. The US government, General Accounting Office, did a comprehensive study, then concluded no significant difference in harmful effects between psychiatrists and psychologists. So it's misleading to take an isolated example of harm by a psychologist. That's just as misleading as pointing to a rare instance of harm by a psychiatrist. For more than twenty years, the sky has not fallen over New Mexico and Louisiana, where suicide rates fell by five to seven percent.

The sky has not fallen over Guam, Illinois, Utah, Colorado, Iowa, and Idaho since they allowed qualified psychologists to prescribe. The Canadian health ministry in Ontario, Canada, does not expect the sky to fall when they implement prescription privileges for psychologists in the near future. Does anyone really believe that people on Kauai are so uniquely different from these other places that the results are going to be any different with this pilot?

So instead of focusing on imaginary harm to Kauai, we should be talking about the real harm of patients with severe depression, anxiety, untreated psychosis, waiting on average three months without treatment. You can prevent some of those very real bad outcomes by passing this very small, modest step forward. Please pass the bill without any amendments. Thank you very much.

You didn't identify yourself.

I'm sorry. Alex Lichten. I'm the legislative chair of the Hawaii Psychological Association, representing the social workers also at American Family Health. Thank you.

Thank you. Let's see. We have written testimony from the American Academy of Pediatrics in opposition and comments from Hawaii Primary Care Association. Written testimony from Queens Medical Center in opposition. Let's see.

This person, we have Dr. Blaisdell Brennan. Please step forward. Good morning.

Hello. Hi. Good morning. I'm Dr. Blaisdell Brennan, a native Hawaiian physician who has served in rural communities for most of my 22-year career. I stand by my written personal testimony dedicated to the care of patients in rural communities.

I'm also here to stand by HPMA's testimony. And if I might respectfully, sir, I have been employed at Tripler Army Medical Center, and there is no prescribing psychologist at Tripler Army Medical Center. I've also read the GAO report, and the GAO did not state that its prescribing psychologist program was a success. I'm happy to forward that report to all of you committee members. The GAO decided that the 6,100,000 program had only trained 10 psychologists.

And at 610,000 each, it wasn't worth the price. And mind you, each of those psychologists worked shoulder to shoulder with other military doctors at each of their military institutions. I don't want to go into harm now because we have a testimony that elicits cases in which a young boy, four years old, was seriously harmed by a prescribing psychologist in Louisiana and a woman who was harmed by a prescribing psychologist leading to edema, congestive heart failure, and permanent cardiac damage.

That's all in my testimony, and I respectfully work with all the psychologists in Honolulu. And thank you for your time. I'm happy to answer any questions.

Thank you very much, doctor. And if you would like to forward the GAO report to me, I'll share it with members. Yes. I appreciate it. Let's see.

Written testimony from the Hawaii Academy of Family Physicians in opposition as well as the Hawaii Association of Professional Nurses. I'm reading this in the order in which we received testimony. So, written also, on a note that we received written testimony from 3,043 individuals in opposition and nine in support. Let's see. In person, I believe we have Samuel Dutton.

Good morning, Chair Takayama and members of the committee. My name is Dr. Samuel Dutton, and I am a prescribing psychologist. I want to be clear that what this bill proposes is not new. It is not experimental. Prescribing psychologists have been safely prescribing for over twenty years in states like New Mexico and Louisiana, and for more than thirty years in the Department of Defense.

Overall, they have an excellent safety record. Psychiatry may pick one or two cases and say this is what can happen, but I can assure you that in those same states where they pick up those cases, there are many more cases of psychiatrists that have made errors, including fatal errors.

In a 2024 longitudinal study, Dr. Philip Hughes examined over 300,000 patients and found that prescribing psychologists had lower rates of adverse drug events and lower rates of polypharmacy compared to physicians or compared to psychiatrists, but with equal clinical outcomes. I stand by the rest of my testimony. I thank you for your time.

Thank you, ma'am. On Zoom, I believe we have Philip Hughes.

Good morning. Are you all able to hear me alright?

We certainly can, and we can see you as well.

Perfect. Good morning. My name is Dr. Philip Hughes, and I'm an assistant professor in the school of pharmacy and pharmaceutical sciences at Binghamton University. For the record, this testimony is my own and does not necessarily reflect the opinions of Binghamton University or the state of New York. So as a health services researcher, I have spent the last four years studying patient outcomes related to prescribing psychologists.

I've submitted written testimony, which is significantly lengthier than what I'm sharing today, and I stand by that testimony. But I wanted to highlight a few brief peer-reviewed findings. First, evidence shows psychologists are safe prescribers, having safety and efficacy outcomes similar to psychiatrists. Second, prescribing psychologists improve population mental health, reducing suicide rates and improving access to underserved populations. And I'll note that that's with the added caveat that there's only about 300 or so across the nation.

So a small pool of providers is having a large-scale impact. And finally, I wanted to add that that GAO report that was referenced previously did find that the program was not cost effective, but it's important to note that they included the cost of the multimillion-dollar evaluation contract in that evaluation. And when you take that out, it actually does look like that program was very cost effective. And I'm happy to talk with you about that in further detail.

But in conclusion, the current evidence shows that prescribing psychologists are a safe and effective means to address population mental health concerns, and I would be happy to answer any questions you may have about the existing research on this policy.

Thank you. Thank you very much for your testimony.

Let's see. On Zoom, we have Jo Velasquez.

Hello, Chair. Can you hear me?

Good morning. Yes, Chair. Yes. Good morning. I'd turn on my camera, but I think it's not going on, so I apologize for that. Hi there. I'm Dr. Jo Velasquez.

I'm a psychologist in New Mexico. I did my residency in 2013 and conditional licensing in 2015 and an independent license in 2017, and I do focus on pediatric psychopathology. And we talked about 2002 and then I think 2004. So we had a branch running in 2016. We landed a rural hospital contract, and we had a great run there.

They accepted Medicaid and Medicare. There was a service arrangement wherein that hospital received an $800,000 grant or bonus for having a behavioral health career and adding that to the hospital. Our practice now, we take about 50% Medicaid, and 50% is one other. It could be federal or HMO or just commercial insurance, and we are reimbursed. If it's Medicare and Medicaid, then we have an agreement with the various insurance providers where the Medicaid, except the, I'm sorry.

Medicare picks up psych therapy codes, and then Medicaid comes in and pays for the prescribing codes with the E and M codes that are used by nurse practitioners and physicians across the health care field. So I stand by my testimony. I am in support of this bill, and I wish you all the very best in getting this passed and caring for the people out of Hawaii. I do stand by, I will be standing by. You have a good one from me. Thank you, Chair.

Thank you, doctor. Let's see. That's all the testimony I've received. Anyone I missed who wishes to testify? Please step forward.

Aloha, Chair Takayama. My name is Melissa Pavlicek. I asked my office to please submit some personal testimony for me prior to this hearing. I apologize that you don't have it in front of you. Most of you know me as a professional advocate, and I do work with the Mental Health Coalition.

But I have been testifying on my family's personal story, and what I feel has been lacking from this conversation is the extreme need for mental health services in our state. Like Mayor Kawakami, I lost a family member to suicide, and the impact of that reverberates through our family through to this day. I did not speak of it publicly or even privately for over thirty years.

But sharing the devastation that family members feel when losing a loved one to suicide has become very important to me, to turn it into a force of good. And if we can see psychologists prescribing in a way that can be safe with supervision, with the appropriate safeguards that are in this bill, no matter how small the pilot is, it would make a difference.

It might save a family like mine from suffering. Thank you.

Thank you very much. Did you wish to testify? Please step forward. Oh, I saw you raise your hand.

Yeah. I'm from DOH, and I'm hard of hearing. So you have called me already.

Okay. Thank you. Please step forward.

Good morning, distinguished Chair Takayama, Co-Chair Keohokapu. Oh. I'm distinguished. I'm representing DOH and adult mental health. I'm the medical director for the Kauai Community Mental Health Center.

Our position could be said to be, we're not against psychologists prescribing per se, but this bill would need a lot of work for us to think it was a good one. Let me briefly tell you why. First, we agree there's a need for more mental health people. Nobody disputes that. One of those groups that we need are psychologists.

We've been trying to recruit psychologists for years without much success. We need more of them and don't want to lose them to drug prescribing. So this does not help our mental health workforce crisis. I can get the FQHC psychiatrist if they want one. We do this through the contract of the University of Hawaii, and we've done just fine with that.

There, we don't think that the training proposed qualifies the psychologist to do what they propose to do. It has, they get a master's degree in a year of classes and go immediately to receiving a license. This is unheard of in the other professions. Psychiatrists go through medical school. They start learning to prescribe in the fourth year.

They prescribe in the first year of residency. Sometimes they're not qualified. They operate under an institutional or temporary license for at least one year. Let me move. The specific restrictions that we suggest, I'll just mention a couple, is children and adolescents.

There's no certainty that a psychologist does much of anything about that. They've had a course in it, but they may not have had much personal experience. Psychiatrists have two years of experience before they handle that. We need a rigorous study, not a report, if we do proceed with this program. Thank you very much.

Thanks. I didn't catch your name.

I'm sorry. Oh, question. Anybody have questions?

Your name?

Your name again? I didn't catch your name.

Oh, James Dillon. Okay.

Thank you very much, Mr. Dillon.

Thank you.

Okay. With that, did I miss anyone else who wishes to testify on this bill? Sharon, you on Zoom? Oh, okay. Gregory Masakian.

Okay. I understand on Zoom, we have Mr. Masakian. Please proceed.

Thank you, Chair. Aloha, Chair, Vice Chair, members of the committee. My name is Greg Masakian. I'm here for another bill, but I am interested to testify on this one because I do have some background back in San Francisco with experience doing reach-outs to some of the homeless in the city and understanding that it's for drugs, especially when someone has schizophrenia and they go off their meds. I saw the effect of that and the difference in the change.

So while I do understand that, I respect that the psychologists are trying to get a little bit more power to help. I do have concerns that it does pose a potential liability. And, you know, I know you're going to carefully look at this bill, but I do have two suggestions to get around that.

If it's possible to amend this bill now as it goes through, I would suggest, if there's a possibility, to add a subsidy for additional psychiatric physicians within Kauai, something maybe housing or something in the bill that just addresses the problem. It doesn't try to change, you know, address the problem in a different way, which could potentially introduce a liability. So that's the first thing.

And the second suggestion is educational subsidies or grants, maybe grants, so that the psychologists, if they want to, can go become psychiatrists and get additional training. But I think those two would be where to look, and I think that could actually help solve the problem. So thank you for the opportunity to testify, and I hope everybody stays dry today. Mahalo.

Thank you. Next on Zoom, I believe we have Zoe Wells. Please proceed. Aloha.

Aloha, Chair and Vice Chair. So this is for SB3199. That's the same?

No. It's SB847.

Okay. I'll wait for the next one.

Okay. Thank you. With that, anyone else I missed who wishes to testify either in person or on Zoom? If not, members, questions?

Okay. Let's begin with Representative Hartsfield followed by Vice Chair. Okay.

I'll start with Dr. Doohan. So, Dr. Lewin, I found the testimony interesting because in your final paragraph, you note that there appears to be a psychiatrist on Kauai who's willing to supervise, but currently no psychologist with the requisite master's degree in pharmacology. My understanding of this bill is that it is to assist with addressing the dire mental health needs, especially for residents on Kauai. But given that testimony, how would this bill address that workforce issue?

Thank you for the question. First, I think that a psychologist with the right training could be recruited to Kauai. So that's one way that could happen. There are psychologists who have the pharmacology training that would be required here. I just, you know, think that we should think in terms of, you know, where the, for example, the AHEC grant, which I'm charged with along with our MedicPlus program implementing in the state, and the whole push is for team-based practice.

You know, we do have advanced practice nurses in our state working independently. You know, physician assistants haven't asked for that, but in some other states they're practicing independently. But I think all of us understand the best way to go is a team-based practice where every member of the team is practicing at the top of their license, and that allows the whole array of expertise. So, you know, as an internist with cardiology training, I wouldn't attempt to do neurosurgery. And I think that having a team-based practice where we have this array of skills is the direction we want to go.

And so that's why I'm suggesting that. And I understand the concerns of some of my fellow physicians who are saying that they think this is a path toward independent practice. So I would recommend that we make this an ongoing team-based practice approach, which I think most of the concerns will go away here. And we might not even have to require all the way to a master's degree ultimately with that in that regard.

So, and I also want to mention that this needs to be a limited formulary if we do this. So there are a lot of things to answer here, a lot of questions, and there are some shortcomings. I will also mention, though, the good news in a way is that we have three times more behavioral health resources across the United States today than we had twenty years ago. So we're making some progress, but we haven't made enough progress. There's still a great shortage of service needs. This could address that, but I think it should address it in a quality way.

So there are a lot of

And the best way to do that is in a team-based practice approach, which I think you could require in the bill.

Okay. I'm sorry. So I have a follow-up to that. If the goal is for a team-based approach and there is a psychiatrist on Kauai, why is there a need to have psychologists prescribe medication?

Well, at present, the psychologist wouldn't be allowed to prescribe even in the team because we don't have the prescribing privileges as part of the license of the psychologist. So we'd be expanding the scope of practice of psychologists to prescribe in a limited fashion.

Okay. I'm not sure if that answered my question, because if a psychiatrist is part of the team, wouldn't the psychiatrist prescribe medication?

Currently, the psychologist's license doesn't include prescribing of these kinds of drugs. So we'd be expanding the scope for the psychologist, but we give the psychologist the protection of a partnership with a psychiatrist, which is really the essence of how this could work effectively and safely.

Okay. Vice Chair?

Yeah. Thank you. Mr. Dutton? Yes. Yes.

I'm looking at your testimony, and thank you so much. That's great. Because I think between my colleague and myself, there's this prescribing psychologist piece, and you clearly are doing that work. Share with me a little bit about your training and this piece of doing the pharmacology, of understanding the drug and its interaction.

Yes. So as you know, psychologists spend a lot of time studying mental health and psychology, and they get a doctorate degree, but they don't spend a lot of time studying medicine and interactions. And so the model that we've developed is to get a separate degree after you get your PhD, and this degree is only in medicine and pharmacology. So it's a two-and-a-half-year degree, and I completed that degree. It's called a postdoctoral master of science in clinical psychopharmacology.

And then after you complete the degree, you have to pass a national exam to demonstrate your understanding of the knowledge. And once you pass that exam, then, depending on the state that you're in, you usually have supervised prescribing under somebody appropriate. In my case, it was for about a year and three months. Everything was cosigned, double-checked before you actually start getting credentialed to do prescribing on your own.

Even then, in most states, there is a collaboration between the primary care physician for the patient and the prescribing psychologist where we coordinate with them. We share treatment plans in order to be sure that we're doing things in a safe manner.

Great. Thank you. Thank you, sir.

Thank you. Members, are there any other questions? Seeing none, let's move on to the next bill. Just for the information of the audience, our hearing will go through all of the bills in our agenda. And after that, we will have decision making on all of the bills.

So next bill up, we have, SB 2271 relating to Hospital Licensing. And first up, we have the Department of Health.

Good morning, chair, vice chair, members of the committee. My name is Paula Serios. I am the Chief for the Office of Health Care Assurance for the Department of Health. The department stands on its testimony and support of this measure and available for any questions if needed. Thank you so much.

Thank you. SHPDA, Doctor Jack Lewin.

Good morning again, chair, vice chair. Jack Lewin, SHPDA. We support this. It's a streamlining measure for DOH allowing the same kind of quality through CMS standards and accreditation and allowing them to deploy staff for other purposes. I think it's a good idea. Thank you.

Thank you.

Let's see. Healthcare Association of Hawaii.

Thank you, Chair. We stand with our testimony.

In support. Let's see. And we also have written testimony from Hawaii State Council on Developmental Disabilities and support. Anyone else I missed who wishes to testify in this bill?

If not. Members, questions?

I do have a question. Let's see. I guess for the hospitals, Health Care Association. Question is, are there multiple types of certification/accreditation reports? In other words, right now on in the bill, there are two paragraphs.

One which requires hospitals to provide DOH with an accreditation or certification reports. And number two, requires hospital to hold full accreditation and provide DOH with a accreditation certification report. One, is that exclusive or can they combine them into

I believe that the reason that second portion was put in was to create stronger enforcement language that the hospitals had to provide the actual report to Department of Health. We've been compliant, but in our discussions with OCA and the Department of Health, I think they had just wanted to make it more clear that that is something that hospitals should do, whenever they do receive their certification from any accrediting organization.

Okay. So we'll keep the language separately if we move the bill form.

Yep.

Okay. Thank you very much. There being no other questions, let's move on to the next bill.

SB 2272 relating to Home Health Care Licensing. Similar bill, but dealing with home health agencies. First up, we have the Department of Health in support.

Chair, vice chair, we stand on our testimony and support.

Thank you. And Health Care Association of Hawaii.

Chair, we'll stand on our testimony in support. Thank you.

Okay. I am oh, anyone else wishing to testify?

If not, members questions? And if not, I had a similar question, and I suspect I'd get a similar answer. So let's move on to the next one.

SB 3137 proposing regulation of food, drugs, and cosmetics by the Department of Health. First up, Department of Health.

Good morning, chair, vice chair, members of the committee. Matt Cronin, Department of Health, Environmental Health Services Division. This bill is really to help us consolidate and get better aligned so that we can do a better job, you know, protecting public health in terms of food security, but also supporting businesses and manufacturing and the verticality of the food system.

It's kind of an activity in a line of activities for us that will ultimately result in better implementation. We stand on our written testimony, and if you have any questions, I'm gonna be here. Thank you.

Thank you. Let's see. We have written testimony from the Hawaii Reef and Ocean Coalition as well as the Hawaii Food Policy Purple Foundation. Anyone else wishing to testify on this bill?

Members, any questions? If not, I let's see. I do have a question for the Department of Health.

Oh, I see that.

Okay. So this this measure, as I see consolidates and updates, much of the old language. One of the things it does is repeals a special fund and a sanitation and environmental health special fund, but it doesn't say where the money goes that's in the abolished fund. Is there money in that fund?

Yes. Again, chair, vice chair, members of the committee. Matt Cronin, Department of Health, Environmental Health Services Division. That special fund is funded by all the fees that restaurants and other manufacturers pay in, and that's a huge supporter of the food safety program. It, our intention and I can check with, you know, our team.

Our intention is not the repeal of the fund so much as the movement of the fund consistent with the food safety side so that in 321, which is the general overall Department of Health, you know, authorities, The special fund that was really there to serve the food safety program is aligned under 328, which is the food, drugs, and cosmetics section.

So it's not meant to repeal. And please, if we ever took away our our whole food safety program with Crater, but it is to just re align.

Okay. Yeah. No. That wasn't my intent, but I'm just reading literally the text of the bill. So you're saying that the bill provides for the transfer of the special fund to another

Yes. It's our understanding that it transfers the special fund itself under 328 or establishes a special fund, and then it provides time for money to be transferred to that extension.

Contained in this bill?

Yes. That's my understanding, but I will go back.

And double check.

Any other questions, Chair?

Thank you very much. Nope. None for you. Thank you.

Thank you, Chair. [inaudible]...

Yep. Okay. Thank you.

There being no other questions, let's move on to the next bill, which is SB 2261 relating to a study on physician and dental needs on the island Of Molokai. And first up, we have, on Zoom, AlohaCare, Mike Winn.

Not present, Chair.

Not present.

Okay. We have, written testimony from Office of Hawaiian Affairs, Hawaii Medical Association, Hawaii Dental Service, Hawaii Dental Association, all of them in support. Anyone else wishing to testify on this bill? If not, well, let's see. We don't have anyone to ask questions at all.

So let's move on to the next one. SB 3130

Aloha, Chair. On Zoom, I had my hand up, but I wasn't recognized.

Oh, okay. Didn't see your hand up. Sorry.

No worries. No worries.

Mister Nasekian, you wanna testify on this SB 2261?

Yes. Just a quick comment. I was reading through it. I am interested in some of these bills, but I didn't have an opportunity before today to kind of review these. Again, I'm here just for one.

Again, my name is Greg Nasakian. And one of the things that I always have a concern with is when there's funding for a study, and the study kinda pushes the issue further down the road for another year or possibly two, but then also that we're spending money on the study. And then in this case, the study is specific for one particular medical center or one area of of Hawaii.

And this is a prevalent problem we have throughout Hawaii with the lack of, you know, physicians and and the needs that we have for the island residents throughout the islands. So, the board, in my opinion, the board of this organization should be smart enough to be able to put their own study together, their own report of what's needed without any cost to the taxpayers and then present that to the legislators and put the bill in that way.

But it should be if you really look at this from the perspective of, again, this is one micro community. Why aren't we doing this collectively for the entire state? We just had another bill where we're talking about a lack of psychiatric care. This should be organized as one, If there is a study needed, one big study, and all these different communities need to Kinda collaborate. So, I don't agree with the way this is being done, and I just wanted to voice that to our legislators.

I hope that you look at that more carefully in the next session, Mohalo.

Thank you. Anyone else I missed who wishes to testify? And any questions? If not, let's move on to the next bill, which is SB 3132 relating to syndromic surveillance, which is something I just learned about. First up, we have the Department of Health.

Thanks, George. Dave Johnson with the Department of Health, Disease Outbreak Control Division. We stand on our written testimony in support and are here for questions if you have any.

Thank you. Doctor Jack Lewin, SHPDA.

Chair, Vice Chair, members, I also stand on our strong support for this bill. We've been relying on federal systems, and we need our own to really be as current as we possibly can be. Thank you.

Okay. If you don't mind, doctor, I'd like to ask you to explain what the syndromic surveillance is, or in layman's terms.

Well, we use data coming from emergency rooms, and from other sources of immediate data, to allow us to see ahead of time that there's a crisis that could be caused from volcanic emissions. It could be caused from an infectious disease outbreak that we didn't pick up. It could be from an environmental related issue. It could even be a mental health crisis.

And so, there are ways to get at this and I would mention that SHPDA's working with DOH to eventually take the All-Payer claims database and attach that to real time prescription data and real time laboratory results to offer some of the same kind of work and some of the same kind of service to the DOH to as a public health surveillance system, if you will. It's real time.

This this allows us to begin the direction to to move in that direction, and we we think it's a very good idea for the state, and we have the resources.

Okay. Thank you, doctor. Healthcare Association of Hawaii.

Health care...support. Thank you.

In support. Let's see. Pew Charitable Trusts in support written testimony. Hawaii Pacific Health as well as Hawaii Medical Association, both in support.

Anyone else wishing to testify on this bill? If not, members' questions? I do have a question, I guess, for doctor Lewin, relating to a part in the bill on the last page dealing with confidentiality. It says, syndromic surveillance data shall be confidential and may only be shared pursuant to state and federal privacy regulations. Now is that reference intended to address the manner in which the data is disclosed or the limitations or circumstances under which it may be disclosed like a disease or something like that?

Thank you for that question. We would share the diagnosis and share the conditions around that diagnosis. We would remove all identifiers that would identify the patient. And in many cases, we don't want to publicly disclose even the institutions where these events occur for some circumstances, but we would de-identify and privacy insure any of this data exchange.

We can always go back and find the source if we needed to, but we have to be careful about exposure of personal health information.

Good. Thank you.

Thank you, Doctor. Any other questions?

Okay. Okay. Just, so for clarification, maybe we'll phrase it like data shall be shared pursuant to federal and state laws, regulations, and rules governing health information policy.

Any questions, If not, let's move on to the next bill, which is, SB 3199, relating to emerging mental health, mental health emerging therapies and creating a task force for that. Let's see. First up, Department of the Attorney General.

Good morning, Chair, Vice Chair, and members of the committee, I am Deputy Attorney General Michelle Agsalda. Our department submitted written comments noting that the term entity is not defined or specified, which could create uncertainty about administrative responsibility and implementation. We recommend clearly identifying the entity where the task force will be established. I'm available for any questions.

Thank you. Department of Health, Behavioral Health Administration offering support. SHPDA, Doctor Lewin.

Good morning again, Chair, Vice Chair, members. We fully understand the interest in these emerging therapies. There is anecdotal evidence coming from lots of different places that these kind of therapies, sort of psychedelic-related pharmacology can offer relief from people with severe depression, suicidal risk, people who have suffered PTSD and trauma.

Unfortunately, the federal law prohibits the use of those drugs and so we think it's prudent at this time not to proceed directly with this even though we think it's an area that we believe the federal government will relax the scheduling rules in the near future. We just think that even though we understand the interest is great, that's probably the most prudent direction given the law at the time, at this moment. Thank you.

Okay. Thank you. Office of Wellness and Resilience?

Aloha Chair, Vice Chair, members of the committee, the Office of Wellness and Resilience stand for our testimony in strong support.

In strong support. Okay. Department of Law Enforcement, Jared Redulla on Zoom.

Hello, Chair, Vice Chair, Brandon Asuka, Department of Law Enforcement. Deputy Director's in a emergency meeting, but, we stand on our written testimony with comments. We would prefer that our Narcotics Enforcement Division, be the entity to schedule the drugs if any entity were to do that. Thank you.

Okay. Thank you very much. Let's see. Clarity Project, Ashley Lukens.

Aloha, Chair, members of the committee. Grateful to be here today. I wanted to just zoom out for a second and point to the broader context within which this bill is coming to this committee on this year. We've been down at the legislature since 2020. I remember our first hearing was scheduled in this committee the day we shut down for COVID.

We represent a broad cross section of stakeholder groups. I, myself, am a cancer patient currently enrolled in a clinical trial at Hawaii Pacific Neuroscience that seeks to bridge legal access for patients like myself to psychedelic medicines, which have been proven to significantly improve the mental health outcomes of patients like myself.

This body and the Senate have passed bills every single session for the past three years that have died in conference, and we are working hard to understand how our State agencies are gonna serve us to administer access to these medicines and prepare our State. And so I urge you to continue passing this bill and not only getting us into conference, but helping us figure out where you all want this initiative to live.

Because if our agencies are unwilling to take full ownership on the learning and the exploration and the research needed to prepare the State, we're gonna be woefully unprepared when the federal government does reschedule these medicines.

And we're also not gonna have the trained clinicians available to be able to properly support patients who want access to this care. When you're talking about people that are navigating questions of suicidal ideation and depression and anxiety and navigating terminal diagnoses, it's critical that we recognize that speed is necessary now, not just deliberation. So thank you for the opportunity to testify.

Thank you. On Zoom, Hawaii Radiant Health, Russell Hill.

Hi. Good morning. Thank you for your time, Chair and Committee. I'm a physician on the Big Island in Kona. I've been trained in both emergency medicine and specifically trained in a therapeutic use of psychedelics over the last 3-4 years.

And it's a new paradigm that we're talking about in treating mental health, and it's treating mental health that is both immediate acting and long lasting. That's the goal of psychedelic assisted therapy that's different from many of the other therapies that we have. And to answer some of the concerns previously mentioned, we're not starting right now with, let's start using these different therapies right now, but let's be prepared.

Let's put in the time and the effort, and that's what this task force is looking for is looking at the other places where there is already access and seeing where Hawaii can maybe use the use that knowledge and take a step forward when the time and their situation is right. And that's what psychedelic therapy is all about.

It's about set and setting. And the beautiful part, what we can prepare for now is creating that environment where it's as safe and efficacious as possible. And I think that's what starting things now and being able to move on all these therapies when the time is right, will provide. And I just again, I've submitted written testimony and wanna give my verbal testimony in support of passing this bill. Mahalo.

Thank you. On Zoom, we have Veterans Exploring Treatment Solutions, Logan Davidson. Mister Davidson?

He's in a meeting...so, move on.

Okay. Let's move on to, also on Zoom, Reason for Hope, Jesse McLaughlin.

Thank you, Chair, and aloha. I, testify in strong support of Senate Bill 3199. I just wanna note that this is a, prudent and measured approach, to the state wrapping its head around the implications of the FDA approval of a number of psychedelic assisted therapies that have received breakthrough therapy designation by the FDA, which means they have the potential to be as good, if not more effective than any, current available treatments that we have to treat PTSD, depression, and a number of other, indications.

A...project testimony, touched on a number of these points, but, this is a form of care that does not fit nicely into our current medical system. We're talking about a, supervised, drug dosing session bookended by, intensive psychotherapy, which is a significant deviation from the current, mental health treatment paradigm, which revolves around take home drugs.

And so we we believe that this is a prudent approach for the State to ask and understand, ask the questions and understand the answers to how do we prepare our medical system to help patients receive this care. A number of states, in the US, have set up similar, whether working groups or task forces to dig into these questions. We think this is a great bill and ought to pass and happy to answer any questions y'all might have. Thank you.

Thank you. Thank you. Next on Zoom, Kendall Crum.

Not...Okay. Let's go back to Logan Davidson.

Thank you so much, and and I'm sorry about that delay.

Good afternoon. My name is Logan Davidson, and I'm here on behalf of Veterans Exploring Treatment Solutions to support SB 3199. VETS is a 501-c3 nonprofit organization with a mission to end the disproportionate incidents of suicide among American veterans. Clearly, as has been stated before and as we all understand, current mental health treatment options available to our veterans through VA health care facilities have been far from universally effective.

VETS has supported more than a thousand US special operations forces veterans and their spouses to access psychedelic assisted therapy treatment abroad, paired with preparation and integration coaching. Our veterans and their families need access to alternative therapies that address the complexity of the challenges they face following service to our nation.

As demonstrated by ongoing medical and scientific research, psychedelic therapies are rapidly emerging as an effective tool in treating PTSD, traumatic brain injury, substance use disorder, and other conditions that fuel the disproportionate rate of suicide among the veteran population. This critical legislation is an important step toward addressing the alarming mental health crisis affecting our nation's veterans and ensuring that they have access to innovative evidence-based treatments. Several states have made significant progress in advancing psychedelic assisted therapies.

And by enacting SB 3199, Hawaii will ensure it is prepared for the future of psychedelic medicine and will participate in the development of new therapies for critical conditions affecting diverse communities. Hawaii could lead the way, setting a precedent for the future of psychedelic medicine across the country and across the world.

Finally, we would recommend the legislation be amended in Section 3 to make two simple changes, giving the authority to reschedule to the Narcotics Enforcement Division and changing the time period from 90 to 30 days. These small edits would perfect the legislation and provide reasonable authority to the appropriate entity to oversee state rescheduling after federal action. We urge Hawaii to join other states leading the way on advancing veteran health care by advancing SB 3199.

And thank you to the legislators, members of the committee, and people of Hawaii for allowing me to speak today.

Thank you. Also on Zoom, Christina Rodriguez.

Greetings, Chair, Vice Chair, and committee members. My name is Christina Rodriguez, I'm a registered nurse, specializing in psychedelic assisted therapy and education living here on Maui in strong support of this measure. I had the distinct honor of serving on the Hawaii Psilocybin Task Force two years ago, and I'm currently on the board of advisors for the Clarity Project. I'm trained in the clinical Western medical model, as well as modern psychedelic therapy and research, including being MAPS trained.

And, most especially in in traditional indigenous medicine cosmology is to work with psychedelic plant medicines. I've developed and currently teach curriculum in the use of plant medicines from the historical, ritualistic, spiritual, and ceremonial perspective in the State of Oregon, as well as with UPenn. The medicines in question for research are considered emerging and breakthrough therapies, though science and the medical community are only now substantiating what indigenous communities have known and practiced for millennia.

Plant medicines have traditionally helped people to heal from addiction, trauma, illness, and as well as in preparation for the death and dying process among many other therapeutic applications. It's not a matter of if, but when the federal government legalizes these medicines.

And we need a workforce that is educated and prepared to serve the people of Hawaii when that happens. I personally am prepared to help train and support clinicians and patients here in Hawaii. I ask that you please support this bill. And I thank you. I'm available for any questions.

Thank you. Vicky Farmer. She, oh, go ahead.

Aloha, Chair Takayama, Vice Chair, members of the committee. My name is Vicky Farmer. I flew from Kona to be with you today. I am a veteran spouse. My husband served for 22 years with 10 combat deployments.

He survived the war abroad, but almost lost the war at home. Not to bullets or bombs, but to the invisible wounds of war, complex PTSD, traumatic brain injury, chronic pain. He left the VA on 13 medications. For over a decade, we did everything we were told. We trusted the system.

We followed the treatments, and nothing worked until we found something that did. Treatment backed by research showing real healing for people like my husband. Something that Stanford, Harvard, Yale, Johns Hopkins research continues to prove over and over and over again. These medicines work. We are living proof.

It gave him his life back, and it gave us our life back. Our home is calm again, and I have my partner back, and we are not alone. There are families across Hawaii still living this reality, still waiting for something that works, and this is not theoretical. This is life and death. When one person heals, a family heals.

And together, when families heal, communities heal. SB 3199 prepares Hawaii to responsibly provide access to those who need it most. Veterans, first responders, and families, and many more where other traditional achievements fail. Please pass SB 3199 for all of the families still struggling in honor of those who didn't make it and for those still fighting to this day. Mahalo.

Thank you very much. On Zoom, Robert Farmer?

Can everyone hear me?

Yes. And see you as well.

Good morning, Chair, Vice Chair, and members of the committee. My name is Bobby Farmer. I'm a resident of the island Of Hawaii. I served 22 years in the army, including fourteen years in special operations with 10 combat deployments to Iraq and Afghanistan with over seven years of sustained combat operations in Afghanistan alone. I was wounded in combat multiple times, and I struggle with the physical and invisible injuries.

For over two decades, I was trained to be a weapon and then sent home to find peace. But after seeing the worst that humanity can do to itself, that just doesn't turn off. The war doesn't stay overseas. It follows you home. I sought help through our Western mental health system and did everything I was supposed to do, but nothing brought lasting relief.

It wasn't till I traveled to Mexico through a nonprofit called VETS that Logan just spoke about and received it...treatment that I experienced real healing, clarity, and for the first time in two decades, peace. And I received this from trained professionals who do this on a daily basis.

As a commander of the Military Purple Heart Association on the Big Island chapter 731, I am in full support of bringing this healing to our most vulnerable populations and first responders who deserve to heal. I'm on the front lines yet again, fighting for our veterans to end the systemic suicide rate this country has all but forgotten about. As we sit here this morning, a new generation of veterans is coming behind me.

These are very real conflicts in Venezuela and Iran. That generation is gonna come home, missing arms, legs, eyes, and having those invisible injuries, bringing them home to their families. Just like the World War II and Korean War veterans who fought timelessly for the 1976 Disability Act, I'm here fighting for the next generation coming behind me. We can do better. Please support SB 3199 so veterans like me don't have to leave Hawaii to find the healing they desperately deserve. Mahalo for your time.

Thank you, Mister Farmer. On Zoom, on Zoom, Edith Garcia.

In person.

In person. Sorry.

Aloha. My name is Edith Garcia. I traveled from Hilo today to testify in strong support of SB 3199. I am a combat Navy veteran and a cofounder of the Big Island Veteran Club at UH Hilo. Before ever considering emerging therapies, I did everything that was available within the current system.

I spent years in therapy, multiple medications, including different SSRIs, and even revisited treatments that didn't work before, but they were pushed on me again. At times, it was only enough to help me survive, not truly heal. Along the way, I developed chronic health issues and experienced the very real challenges that navigating the VA system can be, which only added to my medical trauma. I had never used psychedelics before. My decision came after education, not impulse.

It came after exhausting every accessible option. I ultimately had to leave The United States to receive care. I was fortunate enough to to be able to travel. Many veterans in Hawaii cannot. Our geography alone is already a barrier to care.

The impact of these therapies was significant for me, immediate and long-term lasting. At the time, I was doing therapy twice a week and cognitive therapy monthly. Based on my progress, I believe it will have taken me years to reach the level of improvement that I experienced with psychedelics. As a veteran, I am very resourceful. Accessing substances is not an issue.

The real issue is access to safe, structured, and compassionate care. SB 3199 is about building that framework responsibly, so Hawaii is prepared and not reactive. Our veterans should not have to leave the country to find healing, and they should not have to break before they're finally offered something that works. Mahalo for your support. Thank you.

Thank you very much. Vanessa Torres.

Aloha, Chair, Vice Chair, members of the committee. My name is Vanessa Torres. I flew in from the Hilo side today to speak in person because of how strongly I believe in SB 3199. I currently serve as Public Relations Officer for the American Legion Hilo Post 3 and have benefited from legal breakthrough therapies. I'm a retired marine, a wife of a retired marine, and a mother of a marine.

My family knows a great deal about service, sacrifice, and the struggles that accompany them. Having endured devastating series of traumas in service, I was diagnosed with complex PTSD and major depressive disorder. My understanding of mental health conditions is both personal and academic. I hold a bachelor's degree in psychology, yet that knowledge did not shield me from my depression or loosen anxiety script. What it did give me was a clear understanding of the science.

I learned a promising psychedelic research in PTSD eight years ago, taking note, but believing therapy was my path. I sought therapy often after Iraq, but like many with my condition, it worsened with time. I eventually needed a skilled psychologist, and I was along with the lucky ones that found the most caring, skilled neuroscientists whose dedication held the line between my despair and my survival. Despite her best efforts, I was not able to participate in life and the alternatives still felt like an option.

With a bleak reality before me, I did look into alternatives and met a dear friend who connected me with a nonprofit, providing breakthrough therapy that I was looking for.

I underwent two days of psilocybin therapy with safe professional wraparound care. Two days of medicine healed what twenty years could not. The result was not temporary relief. It was joyous restoration. I no longer desire isolation over engaging with family.

Where I would once break, I now stand firm. After decades of anguish, my family was finally able to meet the calm version of me, the one that knows peace. I could never have imagined that I would need this medicine, but I'm here today as a testament of its profound ability to heal. My family endured a heavy financial burden so that I could travel to the mainland for this treatment. I manage the cost, but not all can.

Please support SB 3199 because real support for veterans and first responders is not spoken. It's legislated. Mahalo for your time.

Thank you. Thank you for your time and service. On Zoom, Robin Martin?

Not present? Zoe Wells. On Zoom.

Aloha, Chair and Vice Chair. My name is Zoe Wells, and I've been in strong support of SB 3199. I've personally recovered from addiction and depression and eating disorders that were really debilitating through life. And the reality is people that have complex trauma and depression and addiction, they seek out their own self-medication through many substances.

So there's plenty of substances available on the streets of Hawaii, as you know, and it would be great to provide safe access to the substances that are actually supportive for mental health versus being destructive for mental health.

I mean, the way that alcohol affects people is alcohol is a a far more dangerous substance than these substances that we're talking about today. So just to consider what's currently legal versus what's currently illegal is, a place that I just wanna encourage kind of insight and awareness. I appreciate your time today. Thank you so much.

Thank you very much. Steve, that's all the testimony I have listed. Anyone else wishing to testify? Please step forward.

Aloha. I'm Melissa Pavlicek. I'm testifying on behalf of Compass Pathways, a biotechnology company. You may have our written testimony. You've heard other testifiers request the same amendments that we are.

I just wanted to be available for questions. Thank you.

Okay. Thank you very much. Please step forward.

Hi. Thank you for letting me speak. I'm I didn't know this bill was being discussed. I'm the point person for DOH on it, and I think they picked me because I was, they voted me the one most likely to have tried psilocybin in this week. I don't know.

But, we support it. We suggested, we ask that it not be a committee under DOH because DOH knows very little about overseeing clinical trials. We thought it would be better in an institution. We didn't wanna name one, but we know of one that would be willing to take it.

Otherwise, I I've heard the veteran's story dozens of times. He's exactly right. I could tell you what happens when you treat. We have two drugs that may help. If we're lucky enough that they have nightmares, we can give them Prazosin.

They feel better sometimes. We also will give them Sertraline or another antidepressant. I'd say, maybe one out of five times, it is a really significant impact. What happens when we don't succeed is they start smoking Marijuana. It helps.

It helps a lot, but there's a big price to pay when you smoke Marijuana constantly as you all probably know. This is a much safer alternative, and we're not actually voting to have psilocybin available. We're just gonna study the issue. And so I see no downside on this. Hope you'll you'll support this. Thanks very much.

Thank you very much. And let's see. Last call. Oh, yes. Please step forward.

Thank you, chair. The Board of Pharmacy I'm sorry. Christopher Fernandez, Executive Officer of the Board of Pharmacy. The board didn't submit any testimony on this, but since Deputy Director was, Deb Radula was, otherwise busy, just wanna let you know he did reach out to the pharmacy, and the legislative liaison supported their amendment for NED to handle their scheduling.

I'd like to testify.

I'm sorry?

Okay. Got it. Thank you. And we do have the EOB testimony.

I'd like to testify.

Oh, yes. Tell us who you are and proceed.

Hello. John Clifton here. Doctor John Clifton. Good afternoon, Chair, Vice Chair, members of the committee. I am also testifying on behalf of Veterans Exploring Treatment Solutions.

I'm the Director of Research and Education to support SB 3199. So that's, again, is a 501-C3 nonprofit with a mission to end the disproportionate incidents of suicide among American veterans, and that's been extremely effective in submissions, helped more than a thousand US special operation force vets and their spouses access legal psychedelic assisted therapy treatments abroad paired with intensive wrap around community support.

And I personally have been intimately involved in psychedelic assisted therapies, research, and clinical care for the past ten years or so. So I've seen many bills like SB 3199 across the country, heard thousands of healing stories, and still I'm deeply moved and become emotional even listening to the testimonies today. So, I'm assuming that SB 3199 will pass here.

So I'd just like to offer some thoughts as you move forward. These task force bills are useful, and while other states have already begun this work, some of the many years into their development process, Hawaii had the opportunity to catch up, and SB 3199 is a meaningful step in that direction.

So the task force will take the necessary deliberative steps to ensure Hawaii is, like, really responsibly prepared to support the research and expanded access as these treatments progress through the FDA drug development and state regulatory processes. They're far into that process. But I would really urge you to act quickly to implement the recommendations from the task force to meet the growing urgency surrounding these treatments.

And, because about a year from now, when the task force puts together the report and makes the recommendations, you'll have a really great opportunity and a significant responsibility to shape what the future of psychedelics, in Hawaii, is going to look like. That year is gonna go by quick. Please don't rely solely on the task force to inform you. At some point, you will be building something that has never been built before, and that's exciting and daunting. And it's very challenging, and it's definitely possible.

So start thinking about what comes next, carve out some time to do your own learning and dig really deep about what this means for the people of Hawaii. Please listen to what the people are telling you, what our veterans are saying. Thank you all to the legislators and people of Hawaii for allowing me to speak today. We urge Hawaii to join other states leading the way on advancing veteran health care by advancing SB 3199. Thank you all.

Thank you, mister Clifton. I hope you're not driving.

I'm not. I am not driving.

Anyone else wishing to testify? If not, members, questions? Vice Chair.

Vice chair.

Miss.... You know, currently, the bill doesn't have an agency that wants to carry the water on this one rather than be volunteered, or voluntold, is this something that Office of ... could take on?

Thank you so much for the question, Vice Chair. I believe that happened...been referred to our, advocates. But we, were all of that said, I will say that we are happy to support in any way that we can.

Great. Thanks.

I had a question for...if there's an allusion to, I'm guessing UH, medical research program., But what I'm not sure is can we pass a bill that doesn't have an unidentified entity and just assume they'll come through, yeah, and they should be testifying that they are exposed, etcetera.

K.

So, I can jump in here with what, the limited knowledge I have. Your process as legislators is clearer to you than it is to me about what you can and can't do in terms of passing this bill. We are in talks with the Department of Social Work. They have received a national fellowship on psychedelic assisted therapy education and training. And the professor, Michael Dematos, actually just had the first social work training class approved for the curriculum there.

So there's already movement inside of UH on these issues. Michael is unable to testify in legislative session wearing his hat because of whatever rules constrict employees from participating, and the legislative sponsors that we've been working on this bill have assured us that there is some sort of magical moment when the task force can properly be handed off to UH so, again, I defer to you all about what that magical handoff is.

I appreciate Office of Wellness and Resilience long term multiyear support for us in terms of housing our previous informal task force. Does it make sense that you at Department of Health? I think we all understand that if Department of Health doesn't want it, that is a poison pill in the bill that is just gonna lead us back to where we are after every session.

So I don't know how to solve the baton pass of the work to UH officially, but we do have support from UH faculty and the dean, and we have support from Office of Wellness and Resilience if you need an interim. I'll also say, just on behalf of OWR, I've watched them have to fight for their own priorities in conference, and we don't want this to be something else that they have to horse trade on because it's also not clearly within their mandate.

I think that's what we're running into is that all the agencies are saying not it.

I understand. Thank you. From members, I hope that's, I hear and I agree that the unstated intent seems to be a University of Hawaiians, but I also hear testimony to the effect that there needs to be a physician, maybe a medical component. And so, combining the two, I think my recommendation will be that we consider JABSOM...housing...that combines both experience in medical therapies as well as some programs IN drug use.

Do you know if they're willing?

No. That's the magic that happens.

Okay. Thank you. No, I'm sorry, we're gonna move on to the next bill. Members have any other questions? Thank you.

We're gonna move on to the next. Members have any other questions? No. Thank you. Let's move on to SB 2591, which relates to noise in Waikiki.

On Zoom, we have, Greg Misakian.

Aloha again, chair, vice chair, members of the committee. My name is Greg Misakian. I currently serve as the president of the Kukua Council, the vice president of the Hawaii Alliance for Retired Americans, a director on my condominium associations board, and I am a former Waikiki neighborhood board member. So I tell you these things because I have a little bit of experience with this issue coming up at the Waikiki neighborhood board and all of this at Kunaak.

I'm just gonna read just one small section of my testimony.

I just have to pull it up here. And I have it I had it up. Excuse my delay. So very a very small snippet of my written testimony that I hope you all had a chance to read. The negative health impacts due to the lack of sleep are well documented.

Chronic lack of sleep caused by excessive environmental noise is known to be linked to an increased risk of dementia and Alzheimer's. Lack of proper sleep also results in increased stress and reduced cognitive abilities. Is this really what we want for our hakuna, who we charge, and our keiki who should start their days at school with a a good night's sleep? And if you all understand what I'm saying and you you understand the impact of this, hopefully, you'll put this forward.

Right now, I know it was amended, so it's or or I I think it's just as a maybe it was originally just as a pilot program, but I think originally they they had it intended to be permanent. I would hope that if there's a chance to amend it again to make it permanent, instead of having us come back in another year, you do that. Most of the states out there many of the states and the big cities, they already have 07:00 established. Some of them 06:00.

But we have a time established for the city services of the trash companies that come out, and we need to be aligned with that. So with that said, for, again, an opportunity to speak with you, and I hope that you, move this forward and possibly amend it to just make it permanent. Mahalo.

Thank you, Mister Misakian. Let's see. We have, written testimony from 13 individuals, all of them in support. Anyone else wishing to testify in this bill either on person in in person or on Zoom? Seeing none by those questions.

Seeing none, let's move on to the final bill on the agenda, which is SB 2804 relating to commerce. First up, insurance commission.

Thank you Chair, Vice chair, members of the committees. I'm Justin Chu from the insurance division. We stand on our written testimony providing comments.

Okay. Thank you, Mister Chu. HMSA, Jennifer Diesman.

Good morning, chair, vice chair, members of the committee. Jen Diesman with HMSA. We appreciate the legislature looking into this issue because, HMSA is obviously very concerned about ensuring access to health care services, as well as creating affordable health care plans. As many of you know, we are, very actively engaged in the community, working on creating workforce development programs, as well as recruitment retention strategies with JABSOM and others to ensure that there is appropriate access in the healthcare delivery system.

I think the concern we have with this bill is that it is ambiguous and wrong and is intended, I think, potentially to actually be anti competitive even though inserted into a section that is intended to help the competition.

We are concerned because that language is so broad that it could it could essentially impact anything from the idea of a clinic closing because they're unsustainable, unfortunately, because the government program funding is caught at the federal level as well as a practice of multiple positions where one physician might retire and they're unable to recruit another physician. He's also somewhat ambiguous because it aligns to federal statute and when you insert new language into what aligns to a federal statute, that could be confusing for regulators.

We are also regulated under the state insurance commission and the state insurance division. They regulate our premium rates, so the concept around increasing health care costs could be confusing to our regulators as well. Given all of that, we understand the legislature's interest in this issue, so we hope that there are other measures alive that we could collaborate on and ask the AU to further this one. Thank you for the support.

Thank you very much. Hawaii Association of Health Plans, Rachel Wilkinson.

Morning, chair, vice chair, members of the committee. Rachel Wilkinson on behalf of the Hawaii Association of Health Plans providing comments. As noted in our testimony, we do have concerns with the bill as written. We believe that it's overly vague and broad, and we also share many of the same concerns raised by the DCCA and regarding regulatory uncertainty and potential overlap. Thank you.

Thank you very much. Anyone else wishing to testify on SB 2804? I'm sorry. Did were you raising your hand? Okay.

No. Okay. Never mind. Sorry. Members, any questions? No questions?

Go ahead, Representative Hartsfield.

Okay. I have questions, but I'm not sure who to ask. So I'll I'll just start with if TCCA could come up. Okay. So I'm trying to figure out what clarification is needed in terms of the interactions between chapters 480 and 431.

So I'm hoping you can give us a brief explanation as to what your department would want to see if it's your work or.

I I think I could speak to what we currently do and what we think the bill currently does. But as to proposed amendments or clarifications, I'm not sure that we can speak.

Okay. No. That that would be helpful thank you.

Yeah. So our our department has regulatory authority over rate increases or just approving rates generally. Rate increases or just rate approval. So even if they don't increase, we we would approve that. Right?

So under under the insurance code, we we approve any rates. So we determine whether rates are excessive, inadequate, or unfairly discrete. That's the standard that we use. And we have actuaries that review what any of the insurers proposed to us. They the you know, I I can only provide a a general review of the rate of process, but they submit the rates.

Our rate and policy analysts look at the rates of proposed plans. Our actual rates review them. They they look at what the assumptions are made by the plan, and they start to question those. There's a back and forth. And and then at at you know, they come to some agreement as to what what the rate for the upcoming plan year should be, and then that gets proposed to the commissioner commissioner or dispenser.

So the concern here is that 480 is is not an insurance statute. It's a, you know, office consumer protection and attorney general statute. Right? So it says under the new statute, any increased insurance rate if a merger or acquisition increase insurance rates, then the attorney general or any individual could sue to prevent that from happening or consume damages. And so our concern would be that, you know, our our statute allows us to approve a rate increase.

And so if we approve a rate increase, but some individual says, well, there's a rate increase, and we think that's due to this merger or acquisition, then we're going to sue. Right? So that would be determined by a court, and we're just unclear what involvement, if any, that the legislator would want us want us to have in that.

So that that's our primary concern is that we have on one side, we do approve a rate increase, and on another, there would be a a separate avenue for an individual or the attorney general to to bring a lawsuit to say, we dislike this rate increase. We think it's due to this a a transaction under this statute, and we'll try to figure that out.

Okay. That that is helpful. Thank thank you. Of course.

Oh, Marten.

Yeah. Thank you. So I assume this is looking at the merger. Right?

For sure.

That is probably the intent of this. And I feel like though, were there to be a merger and it turned out there was adverse consequences, you know, by the time this is enforced, I guess, it's already kind of too late, right, in terms of, you know, if if that if this is something that would come after, right, the enforcement, you wouldn't be able to prove in there was a decreased access to health care until after.

Given the the new statute? Okay. So we we would make that determination. Right?

That would be a judge brought by a lawsuit, right, the attorney general or an individual.

After there has already?

Right. Right. I I assume that's how this works. I'm not an expert, but.

That's how I think the statute reads that if if the transaction causes this to happen.

Right. But this isn't something that would, gain that would prevent a merger from happening.

I'm I'm not sure about that. I could

Thank you. Thank you, chair.

Thank you. Members, any other questions? Seeing none. Let's move on to this evening. Great.

Okay. Members, thank you for your presence this morning. First up, we have SB 847, a somewhat controversial bill dealing with prescriptive authority for psychologists. I appreciate the discussion, and on our testimony received-- this actually is the first public hearing on this measure because it was revised after the last Senate hearing, so no one's had a opportunity to testify on this latest proposal until today.

I know there are many questions and hesitancy about what's being proposed, and that's reflected in the testimony we've heard from the medical community, but we also hear loud and clear that the need for more mental health resources statewide but particularly on the Island of Kauai. So what I'm about to say reflects everything I've been able to absorb from all sides which is that we should do something to improve the situation but be cautious in doing so.

So I propose that we advance SB 847 with several amendments. First, keep this as a three-year pilot project only at a federally qualified health center in Kauai. Secondly, specify that qualifying psychologists may prescribe medications only under the supervision and approval of a Hawaii-licensed board-certified psychiatrist, taking the recommendation of SHPDA. Third, that patients must be between the ages of 18 and 65, as recommended by several medical testifiers.

Fourth, that prescriptions not include controlled substances under Schedules II to V and that no off-label drugs be allowed. This is a recommendation by the state health department. Also, adopt the recommendations of the Board of Psychology that the effective date be from July 1st, 2028 until June 30th, 2031. Three years.

Further, that qualifying psychologists, as recommended by the board, have, quote, completed specialized education and training in preparation for prescriptive practice approved by the American Psychological Association and the Board of Psychology; at a minimum, completed an education and training program in clinical psychopharmacology that is designated by the American Psychological Association to prepare a licensed psychologist for prescriptive authority and approved by the Board of Psychology.

Finally, I would shorten the preamble and make further technical improvement of changes for clarity, consistency, and style. Finally in the report, I will note that other facilities that may be considered as alternative sites on Kauai would be Wilcox Hospital and the Samuel Mahelona Hospital. Those are my recommendations, members, and I am open to your comments, questions, or concerns.

Oh, Chair, just some some comments. First, I wanted to thank everyone that testified. The testimony was very helpful in terms of how people feel about this bill and how it should move forward. I'm also appreciative of the amendments recommended by the chair, and many of my concerns have been addressed with the amendments, so I'm gonna be voting aye.

Thank you.

Thank you, Chair.

Representative?

Thank you, Chair. I appreciate your amendments. I still have some concerns about the FQHC's capacity, so I'll probably be voting with reservations.

Understood.

Any other members with comments? None? Okay. Vice Chair for the vote.

Thank you.

Thank you, Chair and members. Voting on SB 847 Senate Draft 2. Chair's recommendation is to pass with amendments. Chair votes aye. Vice Chair votes aye. [Roll call]. Thank you. Chair, your recommendation is adopted.

Thank you. SB 2271 relating to hospital licensing. I agree that this proposal provides for a more efficient process for hospitals as well as DOH. So I'd like to move this forward with technical amendments. Questions, comments, concerns?

Thank you, chair. Members voting on SB 2271 senate draft one. Chair's recommendation is to pass with amendments. Noting all members present. Any members with reservations?

Vice chair for the vote.

Any members voting no. Chair, your recommendation is adopted.

SB 2272 relating to home health licensing. I'd like to move move this forward similarly as a house draft with technical minutes. Questions, comments? Vice chair of the vote.

Thank you, chair and members. Senate Bill 2272 senate draft one. Chair's recommendations to pass with amendments. Noting all members present, any members with reservations? Any members voting no?

Chair, your recommendation is adopted.

Thank you, Vice Chair. SB 3137, relating to the regulation of food trucks and cosmetics, three important food groups. Like to move this forward with technical amendments, and I guess that's it. Vice Chair for the vote.

Thank you, Chair and members. Senate Bill 3137 Senate Draft 1. Chair's recommendation is to pass with amendments. All members present. Any with reservations? Any voting no? Chair, your recommendation is adopted.

Thank you. SB 2261 relating to a Molokai study. Supportive testimony. Unfortunately, no one to ask questions of. So I'd like to move this forward with the defective date.

And in report language, note that the bill contains a blank appropriation amount. So I'm taking a stab at it based on prior studies that we've authorized and suggest that $100,000 be considered for the studies should future committees consider this bill. Questions, comments, or concerns? Vice chair for the vote.

Thank you, chair and members. SB 2261 senate draft one. Chair's recommendation is to pass with amendments. Knowing all members present, any with reservations? Any voting no?

Chair, your recommendation is adopted.

Thank you. SB 3132, relating to syndromic surveillance. I'd like to add the language that we discussed with SHPDA, which is that this data shall be shared pursuant to federal and state laws, regulations, and rules governing health information privacy and security. That's on page 6--excuse me--line 6 through 10. And also technical amendments. Questions, comments? Seeing none. Vice Chair.

Thank you, Chair and members. Senate Bill 3132 Senate Draft 1, Chair's recommendation: do pass with amendments. Noting all members present, any with reservations? Any voting no? Thank you, Chair. Your recommendation is adopted.

Thank you. SB 3199 relating to emerging and health therapies. As we discussed, I'd like to move this forward, making JABSOM, John A. Burns School of Medicine at UH, the responsible entity. Also making the JABSOM appointee the chair of this task force. Also, technical amendments for priority, consistency, and style.

And note in the report that noting the in the report that Chitel has expressed concerns related to the fact that pharmacologic pharmacological agents are currently technical, technically illegal under current federal law, and that the task force should proceed cautiously in its study. Oh, I'm I'm sorry.

And another amendment to the bill, which is to adopt the two amendments suggested by the Department of Law Enforcement, inserting the narcotics enforcement division at instead of the farm pharmacy board and also changing the date from ninety to thirty days, both of them on page eight. That's it. Questions, comments, or concerns, members?

Vice chair for the vote.

Thank you, chair and members. Voting on SB 3199. Chair's recommendation is to pass with amendments. Any members voting with reservations? Any voting no?

Chair, your recommendation is adopted.

Thank you. SB 2591, relating to noise in Waikiki by trash trucks. As proposed, the bill actually proposes a pilot project but doesn't specify any penalties or responsible entity. We're overseeing it. So my recommendation will be, first of all, to place this under the Hawaii Revised Statutes under current noise laws, and that statute does provide penalties for citations issued by the HPD, and program would be overseen by DOH as it is currently under, governing other noise violations.

Secondly, I'd like-- there's a blank amount-- blank number regarding the weight of trash trucks, and so I Googled on my own and discovered that trash trucks' weights usually start at 20,000 pounds, so we'll fill in the blank by putting in the supplies of trash trucks over 20,000 pounds. Finally, make-- specify that this is a two-year program that sunsets at the end of 2028. I guess that's it. Members, questions, comments, concerns? Okay. Vice Chair for the vote.

Thank you, Chair and members. Voting on SB 2591, Chair's recommendation is to pass with amendments. Any members with reservations? Any members voting no?

No vote.

No.

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

Thank you. Finally, I guess for starting and ending on controversial bills, SB 2804, relating to commerce. I, you know, look at this bill from a health perspective, and I cannot disagree with the intent of preserving access to healthcare as well as providing healthcare at reasonable insurance rates. I do hear the concern that, as proposed, this measure is probably overly broad, particularly as it applies to the legal and commercial ramifications.

So my recommendation is to move this forward with a defective date to enable discussion-- further discussion of this issue by the Consumer Protection and Commerce Committee should this bill move forward. Therefore, as I said, I'd like to move this forward as a House draft, simply defecting the effective date. Members, I welcome your questions, comments, or concerns.

Chair, just comments. I still have concerns in regards to the bill, specifically to what you addressed, and I believe it would be helpful if the AGs could provide testimony at the next committee hearing. Thank you.

Thank you.

Oh, and I'll be voting with reservations.

Thank you. Any other questions, comments? Seeing none, Vice Chair for the vote.

Thank you, Chair and members. Voting on SB 2804 Senate Draft 1, Chair's recommendation is to pass with amendments. Noting reservations by Ms. Hartsfield, any other members with reservations? Any members voting no? Chair, your recommendation is adopted.

Thank you, members. We're adjourned. Happy Friday.

Happy--