CHAIRPERSONS: Senator Gerratana, Representative Ritter

SENATORS: Crisco, Markley, Moore

REPRESENTATIVES: Riley, Srinivasan, Adinolfi, Baker, Berthel, Betts, Candelora, Carpino, Conroy, Cook, Demicco, Genga, Ryan, Sayers, Scanlon, Zoni

SENATOR GERRANTANA (6TH): Welcome to our Public Health Committee, we're going to start our hearing today. We have a lot bills and issues that we have to take up and just a couple of housekeeping matters and that is of course please do not block the doors, the exits that are from this room. That's a matter of public safety of course. And that for those who cannot be accommodated in this room we do have an overflow, we call it the overflow room in 1C as in cat, 1C. And in 1C you can be comfortably seated and there will be a video screen you can watch the happenings here, which of course are being televised on our CTN. So, excuse me, it's that seasonal thing again. So, if you cannot fit comfortably in our room, be seated comfortably, please go to 1C.

So with that, the other information I wanted to share of course is that, we usually start off in the first hour with elected officials, public officials, legislators and commissioners of our different agencies. And then in the second hour we go to the public and very often we have to switch back and forth. We don't get through the public official list but we will of course be doing that. And this morning we're going to be staring off with a couple of individuals on 5450, House Bill No.5450, and the fist person to testify is Joy O'Meara.

And of course come up right here to the seat, there's a microphone there. And if you would, put the microphone on -- there you go, our administrator has done that and just, state who you are and give your testimony. Thank you.

JOY O'MEARA: Good morning, my name is Joy O'Meara. My son, Jamison O'Meara is who I am representing today for House Bill No.5450, which would allow pediatric use of medical marijuana. My son Jamison began having seizures at 18 months old. Five years later we do not have seizure control. He's tried about 19 different pharmaceuticals. He has a feeding tube because he's on such massive amounts of pharmaceuticals. My son has probably been in the hospital hundreds of times. I can't recall the amount of times I've had to call 911. I do know the amount of times I've given him CPR.

This past September through January my son weakened more than I'd ever seen. He spent weeks not getting up, in which I would just sit by his side, checking his vitals. Bring him to the hospital when I was really worried, for them to only tell me that, I know him best and he's probably just best with me taking care of him. When you watch your child suffer day after day it is the most heart wrenching feeling. Sometimes you wonder how long their bodies can handle this, however, we have hope.

About two years ago, I started to hear about the benefits of medical marijuana in children. For some it's an absolute miracle. Children that had not been walking are walking again. Children that lost their speech are talking again. The results are absolutely amazing. All we want is for these children of Connecticut to be given the same opportunities that children in other states are being given right now. Time is absolutely of the essence. Right now, I have to mention another child, Raven Di'Osso in Trumble, she's in absolute crisis right now, seizing constantly. They cannot stop her seizures. All of her doctor support medical cannabis as well, and they are just waiting for legalization. We really believe that this will change the lives of so many children. Thank you.

SENATOR GERRATANA (6TH): Thank you Mrs. O'Meara. I know it takes quite a bit to come up here and give testimony, Mrs. O'Meara. I don't know if anyone here has any questions of Mrs. O'Meara but can you come back please, so we can ask you some questions? And again, as I said we appreciate you coming up here today.

JOY O'MEARA: Yeah, thank you. It's no problem.

SENATOR GERRATANA (6TH): And for us to hear what you have to say is very, very important, and we thank you so much. I know --

JOY O'MEARA: Thank you.

SENATOR GERRATANA (6TH): And we wish you very, very good luck with your struggle and I hope we do the right thing up here too. With that, Representative Srinivasan has a question for you. Thank you.

JOY O'MEARA: Sure.

REP. SRINIVASAN (31ST): Thank you Madam Chair, and good morning Madam Chair. Thank you Mrs. O'Meara for coming here and sharing with all of us this gut wrenching, heartbreaking story of yours. We definitely appreciate that we know how difficult it must be for you to come here and share that story. And we appreciate you sharing that with us.

You know, as you know, we already have medical marijuana in our state for adults. And so now what you're requesting this committee to look into is to increase that scope and go to children as well?

JOY O'MEARA: Yes.

REP. SRINIVASAN (31ST): So for this committee to look at -- look into this further, which is obviously we are planning to do at the end of this public hearing and so on and so forth. Would you feel comfortable with having a similar structure that we have in our state of a group of doctors and a group of people under the DCP and they would be monitoring and deciding which conditions, which pediatric conditions should be on their list that will be eligible for pediatric marijuana?

JOY O'MEARA: Yeah, absolutely. The benefits for children are almost outweighing the benefits that they are in our research on adults right now. Children that are in hospice care, are starting to thrive. So, yeah we, we are open to the same laws that are followed for the adults, currently in Connecticut.

REP. SRINIVASAN (31ST): Thank you for that. And my final question to you is, that the indications obviously, you are very knowledgeable of the subject matter, living with it on a day-to-day basis.

JOY O'MEARA: That's right.

REP. SRINIVASAN (31ST): -- and exploring what the other states have done, is seizures the only condition that you're requesting that we look into or we should be looking --

JOY O'MEARA: No.

REP. SRINIVASAN (31ST): -- we should be looking into a wide range of medical situations where this would be applicable?

JOY O'MEARA: Yeah, I'm not an expert on the other conditions. I know that there are several. I know some parents might be able to tell you more. I know that children with different disorders and that's -- or other neurological disorders. I know also children with autism would greatly benefit. Those studies are new as well. There's several and no, I haven't looked into all of the other disorders, right now.

REP. SRINIVASAN (31ST): Thank you very much. Thank you Mrs. O'Meara. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you Representative Srinivasan. Are there any other questions or comments? Representative McCarty.

REP. MCCARTY (38TH): Thank you Madam Chair and welcome to you and thank you for sharing your story with us. You mentioned in your testimony that you have some research, that you've reached out to other family. Could you share that with this committee? If you have any other names of individuals that you --

JOY O'MEARA: Oh, yeah I mean we can write up for you, either way if you give me some times and names and how to contact the families in other states. We have another family here today, that did have to become a refugee. They lived in Connecticut and they moved to Maine. Susan is very knowledgeable as well, and she has -- we can get together all the names of the families. It's really easy to get in contact with them because they want to help other states become legalized.

REP. MCCARTY (38TH): Thank you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Certainly, thank you so much. And I think that's it. And again thank you for our bravery in coming up here and sharing your story and we'll keep you in our thoughts.

JOY O'MEARA: Okay, thank you.

SENATOR GERRATANA (6TH): Thank you Mrs. O'Meara. Next is Susan Meehan, followed by Linda Lloyd.

SENATOR GERRATANA (6TH): Welcome back.

SUSAN MEEHAN: Thank you.

SENATOR GERRATANA (6TH): You're welcome.

SUSAN MEEHAN: Good morning committee members, legislators, senators and the Department of Consumer Protection who run Connecticut's program. Thank you for considering (Raised) Bill No.5450. My name is Susan Meehan, and this is my daughter Cindy May. She couldn't walk three years ago. We are medical refugees from Oakdale, Connecticut. We're visiting from our new home in Maine.

Alexis Vertel is a 10 year Texan a medical refugee like Cindy May. She lives in Colorado. This eloquent young lady spoke to thousands in her home state last week, threatening to one day become governor to change the laws if that's what it takes. She said, about her first experience with medical marijuana. It was a brown oil in a glass bottle that smelled like a skunk. After nearly daily seizures in Texas, today Alexis is 348 days seizure free, taking the THC high cannabis in Colorado. The law doesn't make any sense, it's time we change it. And I only hope that if a kid can figure this out, that our legislators and our governor are smart enough to figure it out, said Alexis.

I wonder what it would have been like if we had treated Cindy May with cannabis when she first came home to Connecticut, when she was three years old. She was to start from birth to three with no developmental delays. What if we could have saved her brain from the thousands of daily seizures she suffered an hour. And the 4-10 grand Male: seizures she suffered daily. US Patent No. 6630507-2003 Cindy May's birth year, cannabis is a neuro protectant and antioxidant.

The US Patent held by the National Institute for Mental health a Division of the Department of Health and Human Services states, no signs of toxicity or serious side effects have been observed. Cannabis is not toxic. I can't say the same thing about the 23 AED's that Cindy May failed, all of them are toxic. The components in cannabis are powerful antioxidants and powerful neuro protectants. Making them powerful, lifesaving medicines for seizures, Crohn's Disease, Alzheimer's, multiple sclerosis, AOS, Downs Syndrome, Cancer. Any disease that thrives on oxidation and to the resulting neurological damage.

Tragically, Cindy May never move back to her Connecticut homeland. From 2013 to 2015, Cindy May and I moved over five times between our homes in Connecticut. This is devastating to her health, her development and her happiness. She started asking when I told her we were going home, which home? We lived on a camp ground in a very cold Maine for three months. This is horrible for Cindy May, for our marriage and for our three older children. I had one senior who stayed behind in Connecticut.

Connecticut Legislators have a responsibility to these other families who have children who hide at home due to seizures. Whose children turn blue and their mom wonders, is this the seizure that will kill him? Whose children starve to death due to chemo. Who are dying from head trauma from Crohn's, from cancers that cannabis can help. Save these children the trauma of running from their homes like Alexis and Cindy May.

It's so hard to relocate a child with special, medical needs. Finding new nursing services, creating a new educational plan, affording the basics.

On February 29th the first foreclosure hearing was heard on our Oakdale home in New London County Court. Using Cannabis since 2013 Cindy May no longer has daily seizures. She still has one or two seizures a week, but for the first time in her life, her baseline EEG is completely normal.

Last year, Cindy May and I and several other families fought in the Maine state house to pass legislation to ensure her right to attend school. Like any other American child, my child has the right to a free and public education. Where other medications with far more serious side effects are administered to children daily.

After two years out of school, Cindy May now attends Coney High School in August Maine. We're not ashamed and we will not hide and we will not run. We have only just begun to fight for our rights to life, liberty and the pursuit of happiness in all 50 states.

Bill No.557 passed in Maine in a veto override by two votes, and our children can now take their cannabis legally at school. Also, it would really be nice to visit home legally some day. Connecticut needs reciprocity. Please help us save Cindy May's friend, West. I think she's having too many seizures to be here, literally she's having dozens of seizures a day, right here in Windham Connecticut.

Cindy May and I thank you for hearing this bill. And we'd be happy to answer questions about her medicine in Maine and how your dispensaries can help.

SENATOR GERRATANA (6TH): Thank you Mrs. Meehan. Thank you for being a tireless advocate. I'm sorry that you had to take refuge in the state of Maine. As I said, I hope we do the right thing this year in the legislature and you know, move with the times I guess. You know we have to look at of course whatever science there is, and depend on you and many others who advocate and contribute to this discussion.

And it's good to see you and Cindy May. And we hope to see you back in our state soon.

SUSAN MEEHAN: Thank you.

SENATOR GERRATANA (6TH): Thank you. Are there any questions? Representative McCarty.

REP. MCCARTY (38TH): Thank you Madam Chair. And just a quick comment if I may. Just thank you for being here today and for sharing the story of Cindy May, and I just would like to also say, I'm so very pleased to hear that she's doing much better and she looks wonderful today. So, I just wanted to thank you for sharing that story.

And then just a quick question, could you just comment, so the cannabis oil you say was beneficial in stopping the seizures. Can you just describe or I'm not sure if you can, just to tell me what kind of medication may have been used prior to the cannabis oil that did not work?

SUSAN MEEHAN: Okay. Prior to the cannabis oil Cindy May tried just about every antiepileptic medication on the market, from America, from Europe, from Canada. She tried many medications that children are currently on like ONFI before it was even ONFI. It used to be called Frisium, we imported from Europe on an IND. All of those medications made her seizures worse.

When we left Connecticut in 2013, Cindy May couldn't get out of that wheelchair. She was 65 pounds, and she was nearly five feet tall. She was very thin. She was malnutritioned. She couldn't eat, she couldn't walk and she could barely talk.

The medication she uses now, she's off of all of her pharmaceutical medications. She is still seen by her neurologist, John Gitanus in Boston, Massachusetts. He's the Chief of Pediatric Neurology at Tufts University and she is still followed closely by him but we're down to seeing him just about every six months from monthly because she doesn't need to see him as much.

She takes a combination of different marijuana medications. Her primary medication is actually THCS, which is an acidic form of THC and it's the non psychoactive form of THC. It's basically if you were to consume marijuana raw, you would be consuming THCA. THCA, when you add heat and time, you convert it to THC, which is the psychoactive component in THC.

So that's not to knock THC. THC is actually used as her rescue medication. When she has seizure, just like we used to use Diastat. Diastat is Valium that's administered rectally. She is actually administered THC rectally to stop a seizure that goes into a full generalized seizure where she's not breathing. Those, still happen occasionally, and she also takes CBD, which CBD you've probably heard the most of from Colorado and the Weed Shows on Charlotte Fahey. CBD has to be used very cautiously with Cindy May, it actually increased her myoclonics but it is stopping one category of her seizures. She takes about 1 mg of CBD a day.

Connecticut's proposal is, it's phenomenal. You have an excellent program run through a pharmaceutical system and one thing you've done that I'm so jealous of, is you've protected your healthcare workers. You've protected your nurses, your doctors and your healthcare system right from the get-go. You've rescheduled cannabis as Schedule 2 in the State of Connecticut, and you've protected their licenses. That's phenomenal no other state has done that.

The other thing that I want to mention that when your dispensary start administering, making medication for children, what's critical is that they provide for repeatability. If they make a medication, they should make it with one strain and they should make it so they can repeat it. Because not everything works for every child. So, making something repeatable just like the pharmaceuticals, you don't want your Keppra to change. Even changing brand names hurts sometimes.

So it's very, very important that they consider when they're making pediatric medications, that they're ready to repeat those. That they keep those strains in process.

REP. MCCARTY (38TH): Thank you for that additional information. And thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Representative Scanlon, followed by Representative Ryan.

REP. SCANLON (98th): Thank you Madam Chair. Mrs. Meehan, thank you so much for coming today and yu clearly are a very, very educated and big champion for your daughter and it's great to see that.

A lot of what you just have said today is going to stick with me for a while because of your passion but the single biggest thing that you said, that's going t stick with me is you called yourself a medical refugee. And in this country, in the news every day we watch stories of refugees in places Syria, and you've described yourself as a medical refugee in the State of Connecticut.

Talk a little bit about that for myself and other members of the committee and explain what that feels like for you as a Connecticut resident to have to go somewhere else to get your daughter the healthcare she needs, similar to how people in other countries right now that are being torn apart by other things, are fleeing where they live.

SUSAN MEEHAN: Being a medical refugee literally tore our family in half. My husband still works down here. And he can't retire until he is 55. He's turning 50 this year. And I had a daughter who was a senior in high school when I ran to Maine with Cindy May in 2013. I have to be honest with you, you don't tear your family apart at the seams without knowing something is going to work. So w obtained marijuana when we lived here in Connecticut and we used it for Cindy May and the result was 92 days seizure free. Until the police raided the grower's grow, and destroyed the plants that were saving my daughter's life, it was illegal and it shouldn't be.

But we knew that it would work, so our obligation to save Cindy's life and move her to Maine where it would be legal was priceless. We lost everything in Connecticut. We're in the process of losing our house. We lived in other people's homes in Maine and we lived under conditions that weren't ideal. And we had to re-establish nursing services. It took us two years to get a stable home in Maine and to get Cindy May enrolled in school because getting a special needs child in school is no picnic. You're dealing with IEPs and special health needs, and a lot of things that Connecticut had dealt with since Cindy May was three years old, we suddenly were thrown into a new school system who didn't know Cindy May, who didn't know us, who didn't know her seizures, who didn't know what her baseline looked like. And she was changing so fast in Maine, it was really hard for us to say what her baseline was.

So we were refugees in the true sense of the word. Running from a state that legally we couldn't live in and letting the house go in Oakdale, Connecticut because legally we can't live there and I can't afford to pay for two households any longer.

REP. SCANLON (98th): Thank you very much for answering that, and thank you very much for coming today.

SUSAN MEEHAN: You're welcome.

SENATOR GERRATANA (6TH): Thank you Representative Scanlon. Representative Ryan.

REP. RYAN (139th): Yes, thank you Mrs. Meehan, it's good to see you.

SUSAN MEEHAN: Thank you.

REP. RYAN (139th): I appreciate you coming down again and for giving us your testimony. I know last year's Bill after we went through quite a bit of hearings, in the end you had some concerns about the final version of the bill. Has this year's Bill made those corrections so it would work well for Cindy May?

SUSAN MEEHAN: This Bill is, is much better. What you, what you've improved upon, first your system is more established. Your dispensaries are more established. And you've also, you've also placed into this Bill that for pediatric use, the dispensaries won't be allowed to sell the smokable form of marijuana. So they must produce an oil, a medication an extract or something that, that can't be smoked for children.

My child has never smoked a joint. And that's important. You don't want you know adults getting their child approved and I can't think of any parent who would do this, when their child's life is in jeopardy but just the same, you've provided that protection. And additionally, it's very overwhelming as a parent, you get this bag of weed and I'm like okay, now what? So Connecticut has taken that step. In one sense you've taken that control out of parents but I'm finding more and more, parents don't want that control. I'm comfortable with that, with the mathematical and scientific background. However, I have so many parents that call me, begging me to help them make a medication because they really don't get it, and it's not something you normally do in your kitchen.

So I think what Connecticut is doing is definitely a step in the right direction. I have to make her medication and then I have to bring it to the lab and have it verified. You've taken that step right from the parents and you'll be doing that ahead of time the labs will be making that medication, providing test results with the sale of that medication that is now in a form that the child can ingest orally or rectally if they need it for a rescue medication. So that's a phenomenal improvement.

REP. RYAN (139th): Thank you, I'm glad we did something right.

SUSAN MEEHAN: You're welcome.

SENATOR GERRATANA (6TH): Thank you Representative Ryan. Are there any -- Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you very much for coming here again for this session. You give a compelling story and I'm glad she's doing as well as she is. Unfortunately you're a medical refugee but I'm glad she's getting the medical treatment and hopefully we'll look into it more into this session.

For how many years now has she been on the medical treatment?

SUSAN MEEHAN: Since 2013, so it's just about three years.

REP. SRINIVASAN (31ST): Three years, fine.

SUSAN MEEHAN: Well it's two and a half years.

REP. SRINIVASAN (31ST): Thank you, thank you. And during this time that she is on treatment, you know you did say that she occasionally has breakthrough seizures and that unfortunately is to be expected but always by and large, well controlled, that is a more important thing. Has she had any untold side effects of this medication in any way, any other changes that you have observed in her when she's being treated?

SUSAN MEEHAN: Cognitively, she has improved in leaps and bound. And it's hard to say, is it the -- is it a direct result of the marijuana? I suspect it's a combination, you know. She's no longer on the powerful benzodiazepine that she was on. The Diastat several times a day. She was drugged on Valium 4-10 times a day. Often she was hospitalized. She was also on a barbiturate, phenobarbital. Some coming off of those barbiturates and those benzodiazepines has a lot to do with her cognitive improvement. I don't know that she'll ever be "normal" because she had so many seizures and so many medications that damaged her development.

However, the CBD s amazing. Most adults that take CBD, report an immediate cognitive brightening. They're like wow it's like turning on my brain. So, but CBD is not the cure for all children or for all adults with seizures. CBD works well for some kids, and it certainly, probably is what most kids should try first because of its unbelievable success in Colorado and in Maine and across the country. But it's not the end all, be all. And a lot of kids like Alexis in Texas and Cindy May in Maine need a lot of THC-A or THC to also control their seizures. But we've noticed developmental gains. I'm not sure if it's the decrease in the other medications or the marijuana. She very rarely appears "high." It's only maybe happened twice and some of those problems are when other caregivers have misunderstood directions and overdosed her. She had a 10 times dose one time and I came home and she was silly, she was ridiculous, and she was starving. And I'm like you know dad, what did you give her? What did you give her? And he's like I gave exactly what you said, I gave her 2.0 and I'm like oh my God. It's .2 -- 0.2.

So the good news is, that there is no known overdose of cannabis that would harm her that would kill her or cause permanent damage. It did make her silly and it did make her hungry. An overdose of Valium to that extreme, a ten times overdose of Valium would probably kill a child.

REP. SRINIVASAN (31ST): Thank you and yu answered the, you know what we ask -- what I was looking for in terms of the unintended consequences of the medication, which is always a possibility, but as you said, even given at ten times the dose, accidentally of course, the only side effect was the silliness and probably not eating at that particular time. Other than that, you haven't observed on any other occasion when doses were given either excessively or even on a normal schedule, that she had any negative impact of being on the medication?

SUSAN MEEHAN: Nothing long-term. Excess CBD will actually make Cindy May very anxious and agitated. It wears off in a few hours, but if she has too much CBD, and that's actually a good indication that she's getting too much CBD is when she starts to get anxious and agitated. We have her levels checked and oftentimes it's when her CBD is too high.

REP. SRINIVASAN (31ST): Thank you, and I hope you continue to encourage her to be the governor one day.

SUSAN MEEHAN: Thank you.

REP. SRINIVASAN (31ST): Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Alright next to testify is Linda Lloyd.

LINDA LLOYD: Good morning.

SENATOR GERRATANA (6TH): Good morning.

LINDA LLOYD: Good morning, honorable representatives and senators of the committee. My name is Linda Lloyd and I'd like to thank you for considering my testimony today. My six year old son, Henry has catastrophic temporal lobe epilepsy. He started having seizures at the age of 2 and as time passes his seizures increase in intensity and in frequency. Without warning, Henry will instantly drop face forward and start having convulsions. He cannot break his fall so his face often bears the impact. His seizures last an average of three minutes in which he stops breathing and turns blue. With every seizure I feel the same grip in fear that this is the one that won't stop -- sorry. Sorry.

SENATOR GERRATANA (6TH): That's okay, we understand. I think we all feel very empathetic.

LINDA LLOYD: -- that this is the seizure that will take my son.

SENATOR GERRATANA (6TH): Tell us a little bit about what has happened subsequently. I think you can -- thank you. Henry has tried 13 different medications. Sometimes combining five at a time. He's tried the modified Atkins diet, a ketogenic diet only to have his seizures double. None of these treatments were successful. Therefore he's considered refractory.

Like Henry, a third of the people who are diagnosed with epilepsy cannot be controlled with pharmaceuticals. The side effects of these medications especially benzodiazepines are as devastating as the seizures themselves. Some side effects include anxiety, depression, self-harm, aggression, cognitive slowing and hallucinations just to name a few. And with these medications Henry to decline, having more and more seizures.

It's had a profound effect on his memory, behavior, cognition and development.

Without other treatments available it would seem Henry's last option is invasive brain surgery. Removing almost half of his brain as well as dividing the two hemispheres would only palliative at this point and not curative. The doctor's hope is to maybe slow down the seizures and therefore the decline as well.

I find it horrific that this is the only option we have left. But through diligent research I know that this is not the case. I've exhausted every possible option except for one, and that's medical marijuana. It's viable and often very successful treatment for epilepsy, even though I was difficult to treat seizures. How can children not be afforded this opportunity to at least try this treatment to possibly stop or reduce their seizures, their seizure meds and the side effects that go with them.

In the seizure community which is very close especially on-line. I frequently read of someone who is lost to epilepsy, this is on a regular basis. But multiple times a day I also hear these success stores of children who've tried everything -- have tried everything else, have stopped or greatly reduced their seizures using medical marijuana. Many of them, at the same time make huge strides in development and cognition as well.

I grew up in Connecticut, my family is here, my friends, my support system. Please don't force me to leave my home to try this. Thank you.

SENATOR GERRATANA (6TH): Thank you. Thank you for your bravery too, coming here today, and giving your very powerful testimony. And as I said, I hope our committee does the right thing, and ultimately that we can give you the help that your son Henry needs. And I deeply appreciate the testimony, not that -- just what you've given here orally but also it was nice to see Henry's face here. Does anyone have any questions? If not, thank you so much for coming today.

LINDA LLOYD: I appreciate it.

SENATOR GERRATANA (6TH): You take care. And we'll proceed with our hearing. Next is Commissioner Delphin-Rittmon, followed by Commissioner Murray. Welcome commissioner.

COMMISSIONER DELPHIN-RITTMON: Hi, good morning.

SENATOR GERRATANA (6TH): Good morning.

COMMISSIONER DELPHIN-RITTMON: Good morning Senator Gerratana, Representative Ritter and distinguished members of the Public Health Committee. I'm Commissioner Miriam Delphin-Rittmon of the Department of Mental health and Addiction Services. And I'm here today to respectfully request your support of (Raised) Bill No. 5456, AN ACT CONCERNING THE RECOMMENDATION OF THE DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES FOR REVISIONS OF THE MENTAL HEALTH ADDICTION AND ADDICTION SERVICES STATUTES. The Diagnostic and Statistical Manual of Mental Disorders fifth edition in 2013, updated by the American Psychiatric Association is a classification and diagnostic tool. The DSM serves as a universal authority for psychiatric disorders and diseases of the United States. Behavioral health disorders including those related to substance use, are identified in this diagnostic and statistical manual. The language change in this bill reflects the current terminology used in the DSM classification manual and we're interested in changing the language to substance use disorders as opposed to substance abuse disorders.

This change in language is important not only as it relates to the consistency with the most recent changes in the DSM5, but the language we know also helps to frame an issue. The use of appropriate language can positively impact self-perception of an individual with substances use disorder as well as influence culture of recovery and environment.

Over the years DMAS and the people we serve have been working hard to change stigma and discrimination of individuals with mental health and substances use disorders. Stigma and discrimination can often be barriers to accessing treatment and recovery supports, and full citizenship.

Using intentional language we know, or first person language that respects the worth and dignity of all persons promotes recovery and reducing discrimination.

Thank you for your time and attention to this matter. I'm happy to answer any questions at this time.

SENATOR GERRATANA (6TH): Thank you commissioner. Does anyone have any questions? Representative McCarty.

REP. MCCARTY (38TH): Thank you Madam Chair and just a very quick comment. I would just like to commend you on your sensitivity to looking at language. I think it means a lot and we want to do all that we possibly can to de-stigmatize and not be discriminatory in our language, so I thank you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you, and thank you for your testimony.

COMMISSIONER DELPHIN-RITTMON: You're welcome. We do appreciate it.

SENATOR GERRATANA (6TH): Next is Commissioner Murray, followed by Deputy Commissioner Brancifort.

COMMISSIONER MURRAY: Good morning Senator Gerratana, Representative Ritter, Senator Markley, Representative Srinivasan and members of the Public Health Committee. I appreciate the opportunity to come before you this morning to discuss Senate Bill No. 294, AN ACT CONCERNING SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITY.

At the outset, I'd like to state that DDS is not in support of Senate Bill No. 294, but I would like to take just a moment to say that we do support very strongly, the principles contained in the bulk of the bill, which is Section 1. And we are grateful to the committee for raising these issues for discussion. The reason we do not support the bill is that we are already doing the vast majority of what the bill requests and we also disagree with some suggestions and I'll tell you why shortly.

I personally very grateful to be here this morning to shed some light on issues that are admittedly confusing to our consumers and their families. It's my goal and the goal of my staff to make communication and the service delivery at DDS easier and less burdensome for all concerned.

I would also like to acknowledge that while we're talking about a bill that is focused on many quote/unquote requirements. These requirements reflect the most human and in many cases, most desperate of needs. I am highly aware of that on a daily basis, and I want to apologize in advance for discussing these needs in technical terms. That is not how I or my staff view these needs.

But to function as an agency supporting more than 60,000 people we must have policies and procedures that are detailed and consistent.

As many of you know, I typically will summarize my testimony. I beg your indulgence this morning to go into some detail of my testimony because of the issues that are involved so thank you. I'll give a brief overview, and then discuss some particular provision.

Section 1 of the bill, focuses on concerns that have been raised by some families regarding communication from DDS on status for funding and services by requiring DDS to share detailed information regularly and in writing and in some cases, by certified mail.

I really do appreciate the frustration of families regarding a perceived lack of information. The DDS system of supports is large and multi-layered. The department worked extremely hard to do as much as we can for as many individuals and their families as possible within our available resources. With great appreciation for family's concerns we must still be cautious about legislation that may inadvertently create unforeseen and unnecessary administrative burdens, which could interfere with our staff's ability to focus on services and supports for as many individuals as possible.

We also must be cautious about sharing protected health information concerning individuals supported by DDS, with those who are not legally entitled to this information.

I would now like to explain the information that DDS shares with individuals and families. There are many processes currently in place that directly address a great number of the good issues raised by the proposed legislation. I will describe that momentarily for both individuals who receive services and for those who do not receive services. And for your information we have also attached the following forms and notices which I will references throughout my testimony. The following forms are a Sample Level of Need Assessment, which we call the Wand Assessment. A sample Person Centered Individual Plan, which we refer to as an IP. Sample priority status notification, and a sample Medicaid Eligibility Determination Notice, three of them actually that we send out when there is anyone who is in danger of losing their Medicaid eligibility.

Turning to individuals receiving annualized funding for services. Individuals and families receive information on an annual basis. A long Level of Need Assessment is done annually prior to an individual plan being written for each individual. An individual plan is done for four categories of people.

One, all individuals who receive services or supports through a DDS home and community based services waiver which encompasses all of our waivers. Two, all children in the behavioral services program. Three, all individuals who receive any DDS funded residential supports including individualized home supports, some of those individuals, is a small number of people may not be covered under our waivers. And four, individuals who pay directly for residential habilitative services.

There is a manual planning process in which the individuals planning and support team reviews the individuals LON and IP. The LON reflects the individual's strength and needs. The LON also include a record of the individual's annualized funding amount. The IP contains the goals, supports and specific services for the individual for the year. The IP also includes a record of the individual's priority status.

Thirty days before an annual meeting, a case manager will send the individual's exiting LON to the team, the team will review and update the existing LAN. This updated LON serves as the basis for discussion about the individual plan at the annual meeting. At this meeting, the individual's team review each section of the individual plan and recommends changes with a particular focus on any changes that may have happened with the LON score. For individuals who do not receive annualized funding for services. Individuals and families can receive information through the DDS Regional helpline. Helpline staff are case managers who can provide information on how to apply for admittedly limited DDS family support services, or to refer to them to appropriate community resources and services.

If individuals make a request for a service and are granted the service, they are assigned a case manager and follow the annual process out, that I outlined above. If the individual is denied a service notification of priority status occurs at that time. These individuals would not have an individual plan, but may have a LON if they ask for priority status, for the purposes of planning.

I'm going to turn now to some specific sections of the proposed bill. To begin, the definition in the (Raised) bill are problematic in that they do not directly mirror current definitions and agency policies and procedures. It would be confusing at best to introduce a new version of definitions for some of these common terms within the DDS system. For example, the waiting list that individuals are most familiar with is the residential waiting list. To add in days supported to this would cause unnecessary confusion. DDS does maintain a separate day's services waiting list.

As to the requirements proposed in the bill, Section 1B requires that a copy of the LON assessment be provided to multiple parties including the individual, parents, conservator, guardian or other legal representative.

As described above, this information is shared on an annual basis with the individual and the legal guardian, for those individuals who receive annualized funding and for supports and services. Confidentiality is of the protected health information is a requirement for DDS as it is for many human service agencies.

While many individuals supported by DDS have a legal guardian, many do not. The legislation seems to require that information be shared with multiple person without addressing whether or not those persons are legally entitled to the information. That is something that would have to be very carefully analyzed before we could address anything like that in legislation.

Section 1C, Paragraphs 1 and 2, would require notification of an individual's priority status and the amount of funding budgeted for each service provided by DDS. These provisions are currently in practice at DDS. If an individual has an individual plan, their priority status is listed therein. If there is a change to their priority status, they are also notified in writing although not by certified mail. I should note that there is a cost associated with certified mail, which appears to be, according to my staff, $4.69 per letter. The confidentiality issues noted previously are also applicable to this Section.

Turning to Section 1D, focuses on the DDS waiting list. As written here, is that the intent of this section is the residential waiting list, and would require an update of the waiting list at least every three years. DDS maintains a Management Information Report, which we call The Mirror. It contains information about the residential needs of individuals including the waiting list. It's updated quarterly and is available on the DDS website, I would recommend it to anyone. It is a wealth of information about the individuals that we serve and support, and the services that they access.

I'm going to turn now to some of the provisions regarding the waiting list but before I do that, I would like to take a moment and actually define our waiting list for you. What we use at DDS, which is commonly referred to as the waiting list. There's actually three lists. So the waiting list means people who are not getting services. They may be getting residential supports up to $20,000 but not above that, and they are listed as either an Emergency Priority or a Priority One. Meaning that they need -- their need should be met within one year.

The second list, within the waiting list we call, Other Residential Needs. These people are receiving supports in excess of $20,000 but they need additional supports. They are also prioritized as either an emergency or a priority one.

Finally, our Planning list. Our Planning List is for people who have needs that should be met within two to three years. This is difficult estimate to make, but that's what families have made, or the team has made. This is not an urgent or immediate need. And again, some of the people on the Planning List may be getting funding for day supports, or some minimal residential supports respite or access to other small amounts that we can provide through our family support grants.

So with those definitions in mind, just to add some clarity as we go through some of the provisions of the bill. Section 1D, states that an individual cannot be removed from the waiting list without permission from the individual or other legal representative. This restriction would be unnecessary. If funding is allocated and the individual's needs are met, the individual is considered placed within our database, which we call the Planning and Resource Allocation Team database once their services begin.

If an individual at some point in the future has a new, unmet need they can become activated on our other residential needs list. Meaning they are -- their supports are in excess of $20,000. They have another unmet need, we will reactivate them on the other residential needs list.

Section 1D3, requires a written request to the commissioner in order to remove an individual's name from the waiting list and further requires that the request include a clear acknowledgment of the consequences or removing that individual's name.

Removal from the DDS residential waiting list occurs only under two circumstances. One, an individual's residential needs are fully met. Or two, an individual's residential needs are partially met through an allocation of more than $20,000 at which time as I described -- as I just described they are moved to other residential needs list.

Individuals on the other Residential Needs list and I don't mean to repeat myself but I would I would like -- it's a little bit complex, still have a prioritization as either an emergency or Priority 1, for the additional support that they need. As an example, in fiscal year '15, we successfully met the needs of 134 individual needs on the other, I'm sorry, 134 individuals on the other Residential Needs list. That was 33 emergency individuals and 101 Priority 1.

Having said all that, I understand very well that the waiting list is a confusing way of communicating with our customers and their families. One of my priorities coming in, and that we have launched, is a project to redefine our multiple -- three I should say, waiting lists. A project at DDS is something that we have instituted with (indiscernible - sounds like LEEN) organizational help, which is not a loosely defined project but a very technical term in which we have a very focused process with stakeholders from the community, in fact our waiting list project involves stakeholders from The Ark Connecticut, and also parents, as well as DDS staff members to really clarify our waiting list, identify people who are indeed receiving services. I think that it may be a surprise to many people in this room that people on our waiting list, many of them are actually receiving services from DDS.

So, just for a rundown as of December 31, 2015, here are the numbers associated with our waiting list. The Residential waiting list, we have an 18 emergency individuals and 645 individuals who are Priority 1, that's a total of 663 individuals on our waiting list. The other Residential Needs list again these people are receiving in excess of $20,000 in residential supports. We have 14 emergency individuals and 254 Priority 1 individuals, and that's a total of 931 between the Residential waiting list, and the other Residential Needs list.

The Residential Planning list, which is again people who have needs that need to be met within two to three years, is a total of 1148 people. Out of all of those three lists, the total number as of December 31st of individuals is 2079 people.

In fiscal -- in other words, another calculation for fiscal year 2015, 163 individuals came off the Residential waiting list, the first list that I described to you, including 83 with funding from the waiting list initiative for individuals with elderly caregivers, and 80 who did not receive funding from this year.

With respect to that, individuals were funded recently with a separate appropriation for caregivers age 70 and over. And that was geared towards at least 100 people. We've be able to fund services for 122 individuals, 117 individuals have begun residential support and 5 additional individuals have plans to start this fiscal year '16.

Moving on from the waiting list for now. Section 1A of the bill, requires that whenever funding for services is offered it must be done in writing with notice of an explicit deadline for acceptance or rejection of said funding, and an explanation of the consequences of accepting or rejecting such offer. Including the individual's right to receive additional services or maintain his or place on the waiting list. DDS has concerns about the administration of this provision, and its potential unintended consequences to families.

Establishing hard deadline would limit flexibility and creativity of individuals, families and providers in developing supports within the person's centered system of planning that DDS utilizes.

DDS looks at how to best meet the individualized needs as part of a person's centered planning. There are multiple choices available to individuals including the choice of residential services, the choice of provider, the timing of services and other choices.

All these decisions affect what funding may be required for these individualized services and when the funding is needed. DDS believes that creating appropriate serves is a force for individuals within this highly individualized and person centered model. Requires fluidity and flexibility to maintain the focus on what is best for each individual. This process simply does not lend itself to a legislatively mandated schedule.

I just have a couple, additional comments on Section 2 and 3. Section 2 of the would replace language from Section 23 of Public Act 15-1 of the December Special Session, and requires outreach to stake holder for the report on a plan to implement the closure of facility operated by DDS. This provision is not necessary since the office of policy and management intends to consultant with all stakeholders.

Turning to Section 3, the purpose of Section 3, is not quite clear as written. Um, Section 17A to 18G, which it cites, which is the section of a general statute for Connecticut that requires individuals receiving DDS services to be enrolled in one of our DDS waivers already requires basically what I just said. That anybody who is seeking placement or is enrolled in services must be enrolled in the waiver. DDS works closely with the Department of Social Services regarding eligibility and re-determination. In fact, we have three DSS staff located right in central office, and they are specifically dedicated to assisting DDS staff, individuals and providers with initial eligibility, waiver enrollment, re-determination and other special needs or projects.

These DSS staff, act as liaisons with DDS central and regional office, to resolve specific Medicaid issues or any Medicaid problem that DDS consumers may have.

Special notices are given as you have in your packet of information, are given to individuals and families who are not compliant with the section which requires them to be enrolled in the waiver. Failure to comply with the request to contact, what happens if a person is not enrolled and we are -- and we become aware of that, we send them a notice, saying that they need to talk to their case manager and get this straightened out. Noncompliance with waiver requirements on the part of some individuals, if they don't, after we have notified them three times, that noncompliance is not fair to the number of people on the waiting list who are waiting for services.

With the final notice indicating that termination of supports will occur, individuals are then notified of the right to appeal the decision through the fair hearing process at DSS.

Finally in terms of Section 3, it would not be appropriate for DDS to assist in the identification and securing of private funding for care or services for someone who has not complied with our requirement to be enrolled in our Medicaid Waivers.

So, thank you for the opportunity to testify in detail on Senate Bill No. 291. I'm happy to answer any question that you may have at this time.

SENATOR GERRATANA (6TH): Thank you commissioner. Thank you also for your very detailed testimony in front of the appropriations committee. In front of our health subcommittee, it's very, very helpful. And of course, this is just as detailed and we appreciate, or at least I appreciate, and I'm sure we all do, the protocols that you have in place. And of course the different services.

What happens in appropriations of course, you know well go through that discussion. We've already started our work groups in that.

I do have a couple of questions though. You know I was looking at the section regarding the development of a plan. And I think from your testimony we understand that there is a plan, and that you have a protocol that you follow and of course -- you work with and oversee what I consider to be like DMAS and some of our other agencies a very close relationship with the people that you serve. You overwork and see their, almost their daily lives, you know their day-to-day. As well as how they survive and flourish in our state.

And my question goes specifically to Southbury Training School. We've had discussions in Appropriations, I won't repeat that but I do want to understand a little and I hope perhaps you can give us a little bit more information on what the protocol is there, what you are currently doing to reach the goal of closing Southbury and keep in mind of course any of the court decisions and you're very familiar with that. Because of course, Southbury comes up so often in this building, that you know it should have been closed -- it should be closed, I don't think anyone disagrees with that but at least that -- you can give us a little background and update on what you're doing with Southbury, we'd appreciate that.

COMMISSIONER MURRAY: Thank you Madam Chair. As you know, Southbury is under the (indiscernible) settlement agreement, which was instituted in 2010. That sets forth I think 18 benchmarks -- if I don't have that number correct, my staff with correct me. That we are required to meet in the pursuit of integrating people at Southbury into the community. We have two dedicated staff members at Southbury who work with consumers at Southbury, their guardians, their families, private providers, community in terms of bringing resources and opportunities repeatedly to people at Southbury to show them the opportunities that they have for living in the community.

We have no doubt that there are with a very small number that there may be exceptions. And we guesstimate that number to be about 20 to 25 people who are so medically frail that the prospect of moving them is you know potentially fatal. With the exception of those individuals, our sense is that Southbury as of yesterday is 263 individuals. And we are -- we make every effort that we can introduce them to community settings.

Now that said, they do not have to, under the (indiscernible) settlement agreement, move if they don't want to. Our job is to make sure that we are doing the job for moving people into the community who chose to move into the community as quickly as we can, and that we are continually presenting opportunities to people at Southbury.

SENATOR GERRATANA (6TH): Thank you, my button wouldn't work there. Thank you very much for that overview because I know of course we have debated that in the building, and there is such a wish, I guess that Southbury could close within the year or you know or something along that line. But I appreciate that statement because we do have to be mindful that this is the structure if you will or at the guidance or the law to weigh that we are working with.

My co-chair has some questions too. So I'm going to turn it over to Representative Ritter. Thank you so much again for the very detailed testimony that you have brought.

REP. RITTER (1ST): Thank you Senator, and commissioner thank you for being here. And let me start off by saying I think what my co-chair said earlier, which is, we really appreciate and respect the work that you do on a daily basis, your testimony is most helpful in that it goes section by section. As you can imagine it's one of the bigger issues our community deals with. And to have you here today, and being so forthright and thorough is very much appreciated. And we're very lucky to have you in the State of Connecticut as our Commissioner DDS, so.

COMMISSIONER MURRAY: Thank you.

REP. RITTER (1ST): We're going to hear -- I'm going to say about four hours or so, from people who signed up for the bill to testify from the public portion. And this is what makes it hard, so the one section that I'm trying to understand is that we according to your testimony have drafted a bill, that's already being done. And obviously if it's already being done, there wouldn't have been a suggestion for them to do it. So -- just to clarify on Section 1C, 1 and 2, which requires the notification of priority status in the amount of funding that is budgeted in service. Because I think some of the later sections I agree with you, we've seen that before, but this is some of the new stuff, and you say we already do it. Can you say what might be in your mind the confusion then as to why parents are saying we're not getting this, and they are or what that might be?

COMMISSIONER MURRAY: So in any large bureaucracy nothing is going to be consistent -- I will say that right.

REP. RITTER (1ST): I'm sorry, say that again commissioner.

COMMISSIONER MURRAY: In any large bureaucracy nothing is going to be consistent.

REP. RITTER (1ST): I get it, yes.

COMMISSIONER MURRAY: I will say that in all honesty.

REP. RITTER (1ST): You can see the legislature, yes.

COMMISSIONER MURRAY: So these are our policies and procedures. Whether they are followed to the T, by every single person in our agency or on any given day and I'm not criticizing any of our staff they work very hard. The answer, I will say this, it's a difficult conversation with people. If we do not have the resources to meet their needs. That is a difficult conversation. People have difficult time saying no. People have a difficult time hearing no. I'm not saying that they're hearing different things that what are said. But, yes, we from time to time hear from families. I hear directly from families saying, my case manager told me this. And I'll look at it and then I will most likely will send it to my Deputy Commissioner Jordan Scheff who oversees all of our operations and say, Jordan please take care of this. And if there was mis-information that was given to a family we correct it on the spot. We are very hands on when it comes to that.

So I do think that there are people who do not always get the best information from DDS, and will admit that right up front. I encourage people to bring that to us when that happens. Because all we can do is correct what we know about. Our regions work very hard, but we do operate on a regional basis, in terms of dealing with people's request for funding. I will say Jordan was the regional director for the north region, and is infinitely knowledgeable about these operations, and I really rely on him for these things, so.

REP. RITTER (1ST): A quick follow up and then one more and then committee members have questions too, and may have more.

So if this meeting occurs or the notification is sent out, and someone thinks there is an error or is dissatisfied. One of the things that is so frustrating, I'll use an example right? And I'm not comparing it to but if you look at state agencies people go to DMV all the time and they never have the right paperwork, they never get the right thing. We want to make sure that in something that is far more important, far more fragile, far more emotional that if there is a error, it can be easily rectified or there is someone to contact. So if I'm a parent and I think and I, I get this letter and I go, that's not right. How hard is it for me to get someone on the phone, or to correspond with me, to look at this or someone else look at that. And I know resources are an issue, but is there an easy way? Is there a number? Is there an easy way to do that?

COMMISSIONER MURRAY: So part of what I didn't read in my testimony, not to you know go into too much detail. At the end of the individual planning meeting, case manager will document the participants in the planning process, will obtain signatures just like at a PBT or an IE -- you know. And there is a form that people sign. So the form states the individual parent, guardian or advocate should contact the individual's case manager in writing if they do not agree with the plan as written. The case manager then has 30 days following the meeting to update the IP and send it to the individual's team. So we do have that policy, they have 30 days to disagree with it. I can't tell you that you know, honestly if somebody came to me after 45 days and said, we missed this, can we please submit this, of course I would take it. So we do have a process it does happen in writing and we do need these things to be in writing with the case managers.

I will also say again, with the caveat that people have bad days, and not everybody has the best experience every single day that they're dealing with DDS. I also repeatedly get emails and phone calls about case managers that are people that just go above and beyond and are like saviors to families, in terms of what they're able to help navigate through system -- an admittedly very complicated system. Based on federal waivers and you know reimbursements from those waivers that we have to do.

REP. RITTER (1ST): Thank you. Last one for me commissioner. This PRAT database, the plan and resource. So we had testimony last time on, related but related at the same time and it came up. Just so I understand it, if I'm the guardian or legal representative for an individual, I can take some sort of monetary amount, I can take a monetary lump sum, correct? To receive certain services that takes me off of what we all would it's not defined in state statute as the waiting list, is that -- is that accurate?

COMMISSIONER MURRAY: You were going to the other --

REP. RITTER (1ST): The other, you go from the main waiting list right? Which I, I know it's not a state statute.

COMMISSIONER MURRAY: Which are about to change.

REP. RITTER (1ST): Yes, to the other Residential Need list, correct?

COMMISSIONER MURRAY: Correct.

REP. RITTER (1ST): So one of the things that people have said is, when they -- they were not aware that they were removed from the main waiting list to go to the ORN list, and so they said is what we would love to have is at least some sort of, and again, I don't certified mail and that stuff that can be negotiable but what they were saying is, we want to sign something so that we know that if we take this, we're leaving that main waiting list which would be the ultimate goal as opposed to the ORN list.

COMMISSIONER MURRAY: Right.

REP. RITTER (1ST): So what, what happens when this happens? Is there formal documentation and if not, would that really be that cumbersome or difficult, assuming you got somebody on the other issue we talked about. Because that issue has come up a few times and that seemed to me, easy for me to say who doesn't deal with it on a daily basis, but that seemed one of the easier things to work out between the various testimonies that we had heard last Interviewee:, or two weeks ago.

COMMISSIONER MURRAY: Yes, as our policies are stated, they should be notified in writing if they are moved to the other Residential Needs list.

REP. RITTER (1ST): Do they respond by signed in writing saying we --

COMMISSIONER MURRAY: No.

REP. RITTER (1ST): No.

COMMISSIONER MURRAY: No.

REP. RITTER (1ST): So there is no -- there is sort of the, you made the decision, here you go.

COMMISSIONER MURRAY: There is no sign-off.

REP. RITTER (1ST): The acceptance of offer is not there?

COMMISSIONER MURRAY: No.

REP. RITTER (1ST): But they are making that decision what? Verbally to the case manager or how, how is the parent notifying DDS that yes, we'll take this lump sum payment?

COMMISSIONER MURRAY: I, to be honest I'm not sure if I can answer that question as you've asked it. I can check with staff and get back to you, but most people who are you know, looking for additional supports on the Residential Waiting list if they get say $45,000 for you know in home supports or something that really helps them at that moment. It could be all that they need. And they go onto the other Residential Needs list. I haven't seen many examples of people that don't immediately agree with that.

I also say that, when that happens, there is a change in status for some reason in terms of that person's needs. That's why their supports have changed. So there has been a discussion that has taken place. There is notification, in writing about the change that has taken place. And, it's not like we say to somebody okay we're going give you another $25,000 now, and you're going to -- you're going to have this. We're going to say them, we think that we can offer you more funding for example continuous residential supports.

They might be looking for a traditional CLA group home, but we can offer them something less than that this time, considering our resources. And they say great, you know maybe one of the parents is not in the picture anymore or something -- something else has changed in terms of their caregiving situation.

So I hope I'm answering your question. If I'm not, I'll be more specific with my staff, but there is not a lot of no's to that situation. People want to you know, obviously we want to increase the level of service that we're giving to people as much as we can. And we're always looking for opportunities to do that.

Right now we're in a situation, literally as everyone knows, where resources are extremely scarce and we don't have the capacity to do that as we could in the past.

REP. RITTER (1ST): Yes I would love feedback on it again, and I -- because what it seems like is we're actually not that far off here. When that letter comes, maybe before it's finalized there should be some sort of affirmative consent by the parent or the guardian in that case and send it back. But, I will say be careful for what you wish for. Because if you don't sign it, or you don't get it back inside of a deadline of 60 days, then you might have missed that opportunity. So, maybe we'll ask some of the advocate or the parents later but maybe there is a way to do the affirmative consent on both sides, in terms of getting almost a contract, but that's something we can talk about later. So, thanks commissioner.

COMMISSIONER MURRAY: There maybe -- and if I could just add, this is not to excuse the many administrative responsibilities that we have DDS, one of our biggest challenges is keeping our people, consumers and families clearly identified and accurate on our databases. Our private database being our most important database that we maintain frankly. And providers might disagree with me on that. But we really need to have that information accurate. So having that switch over to other residential needs, when those people receive those additional supports, this also is a way of maintaining some fairness to other people who are waiting for supports.

You know so there could be that delay and then also things could get lost. I guess I'm imaging a worse case scenario where it becomes an administrative nightmare. But I do understand the thing behind it and agree with the principle of it.

SENATOR GERRATANA (6TH): Thank you very much. Does anyone else have any questions, yes Representative Demicco.

REP. DEMICCO (21ST): Thank you Madam Chair. Thank you commissioner I appreciate your coming here to testify in such detail and I particularly appreciate how difficult your job is.

COMMISSIONER MURRAY: Thank you.

REP. DEMICCO (21ST): I would like to echo the comments of the Chairs, in that regard. Representative Ritter anticipated one of my questions with regard to the need for this bill, in the first place. Now you stated at the very beginning of your testimony that you don't I think you stated and correct me if I'm wrong, that the department already takes care of most of the things that are listed here. So I guess I'll ask the question in a different -- somewhat different way. If that's the case, why is it that so many parents and advocates have come to me and other legislatures telling us that these things need to be done. In other words, are these things being done in theory but not actually in practice? Or are they really being done in practice?

COMMISSIONER MURRAY: Thank you for that question, and it's a fair question. They are being done in practice. They are the theory of how we operate. But, there may be cases in which they do not happen they way they are supposed to happen. There is always room for improvement.

We have three regions, one of the things, again, that we focus on and not to pick on Deputy Commissioner Scheff but he, his lead area is field operations, and the operations of the various regions and he does a tremendous job. And one of the things that he focuses on is ensuring, actually in some cases creating consistency across regions in how our PRAT teams operated and how we do individual plans and how we do LON assessment, how we communicate with families and individuals. So we do operate as three regions, that needs to be considered in this discussion. Three separate regions. We have done things at central office, in an attempt to consolidate our operations in a way that the regional directors meet with me once a week so that we can really address the fact that in the past, there has been some siloing among the regions and how they operate. I can't say that, that is the only reason but the fact that some families do not get information the way that they should. It's simply the reality of the bureaucracy and I'll repeat again that when those issues are brought to our attention, we address them immediately spot on, because we don't want that to be happening.

And I would encourage people to come directly to us, with any problems that they have. There is no problem in terms of bypassing regions. We've really flattened our organization in that respect. So I hope that answers it, I'm not trying to avoid it. I am just saying there are instances in which it doesn't happen but it is our practice and in our policies and regulations that this is the way that we operate.

REP. DEMICCO (21ST): Thank you for that answer. If I may Madam Chair, just a couple of other questions?

SENATOR GERRATANA (6TH): Oh yes, please proceed:

REP. DEMICCO (21ST): .. Thank you, thank you. I want to go through just a couple of sections of the bill and I know you addressed several of them already. I just want to make sure that I'm clear on this. In Section 1, Subsection B, it says immediately after the department completes a Level of Need Assessment, the department shall provide to the individual parent, conservator, guardian or other legal representative a complete copy of the Level of Need Assessment including but not limited to scoring results, comments, a summary report and any other related information or documents. That's what the bill proposes. Are you going to tell me -- are you telling us that, that already happens? Is that the case?

COMMISSIONER MURRAY: Yes. Here is our Level of Need Assessment and screening tool. You have it, I think in your packet of information. It is extremely detailed. It goes through every aspect of an individual's daily life from social activities to behavioral health, to medical needs to the ability to dress themselves, transportation and you name it. It's exceedingly detailed an individual is given a score from 1-8. And yes, they do receive copy and their legal guardian receives a copy of that assessment tool.

REP. DEMICCO (21ST): Thank you, and I was suggested to me by some advocates that some of the language in this bill should be changed. I'm just curious to know if you would agree with some of these suggested recommendations, that on an annual basis the commissioner shall notify the individual's parent, conservator, guardian, other legal representative of the individual's priority status and of funding budgeted for each service provided by the department and beginning September 30, 2017, the annual notification will include the individual's up-to-date Level of Need Assessment. Does that currently happen and should that happen?

COMMISSIONER MURRAY: That does happen with people who are receiving annualized funding for supports and services. For people who are not receiving supports and services, that does not occur. You know, there is no change necessarily in their priority, if there is a change in need, they would then go through you know, the planning process again in order to change to have -- in order to change either LON or their priority status.

I will say, that doesn't happen all that often. Especially with people who are on our planning list, that's two for three. That's a fact that you know we have deal with.

REP. DEMICCO (21ST): Thank you, and one other suggestion that was given to me what was -- has to do with that upon the request of any individual that has requested services or support from the department, the department shall provide copies of any document used by the department that in whole or in part formed the basis for the department's decisions. Documents shall be provided in accordance with HIPPA ,but HIPAA shall not be used to deny access to the individual's own records. Now --

COMMISSIONER MURRAY: Which, I'm sorry, which section are you in?

REP. DEMICCO (21ST): Well this is just a suggestion that was given to me.

COMMISSIONER MURRAY: Oh, okay.

REP. DEMICCO (21ST): Now the fact that, that was even suggested, does that mean that people are being denied access to their own records or their family members' records currently?

COMMISSIONER MURRAY: No, but could you read that last line one more time, the HIPAA line?

REP. DEMICCO (21ST): Sure, documents shall be provided in accordance with HIPAA, but HIPAA shall not be used to deny access to the individual's own records.

COMMISSIONER MURRAY: Okay, well -- it's hard to speak to language that is not in front of me but that could be as an attorney I can interpret that language in any number of ways. So HIPAA does deny access to people -- to individual's records on any number of levels, not to the individual themselves obviously, or to their legal guardian. But, easily to their parents if they're not the legal guardian of the individual.

I am not aware of any circumstances but I'll certainly check. Where people have gone through a planning process with DDS and that we've based the decision on any kinds of evaluations, records etcetera. We would only be getting those documents from the individual themselves. We wouldn't be getting them from anywhere else. So, it's -- it's, I'm having a hard time imagining a situation where that would occur but I'll certainly check into it.

REP. DEMICCO (21ST): So it -- just so I understand, so we don't have a situation currently where people are being denied access to documents that would indicate why the department made the decision that they made. In other words, everything, everything is out in the open to the extent of the law allows it to be out in the open?

COMMISSIONER MURRAY: To the people who are legally entitled to that information. No, we don't have any secret. I'm not saying that you're saying that but we don't have any secret documentation around individuals in terms of their priority for services or their eligibility or whether or not they can move from you know one aspect of the waiting list to another. We don't have anything like that.

It could be, and this is a guess on my part, but people do ask us where they are on a particular list. You know, am I number 113 on you know the planning list. And that is not something that we do. Right now as we discuss with many members of this committee and other people, our only ability to find services -- to fund new services for individuals, is when they become an emergency. That is the only way that we can do it, with the funding that we have available to us right now.

So there is no you know for lack of a better word, no moving up and down in terms of those lights. When people's status change, you know when something happens in someone's life, and they come in for you know an individual plan, which can happen more than annually as circumstances change then we will look at that, and we may very well make that person an emergency. On either the waiting list or the other residential needs list. Or they may even bypass and they may move from the two you know the planning list up to the waiting list because of what has happened in their life. But we can't keep a ranking of individuals. We have to look at what is the more dire need at that given moment. And it's a very, very difficult process.

REP. DEMICCO (21ST): Thank you very much and a Chairman Ritter indicated, we'll be hearing from folks a little bit later on. I hope you schedule allows you to stick around to hear their specific concerns an suggestions because I think it would be useful for all of us, but you know that, that's up to you.

COMMISSIONER MURRAY: Thank you. If I am not here I will be in my office, I can assure you.

Thank you.

REP. RITTER (1ST): Thank you commissioner and thank you Representative Demicco. I know Representative Srinivasan had a question and then we'll see who is after that.

REP. DEMICCO (21ST): Thanks.

REP. SRINIVASAN (31ST): Thank you commissioner for being here this morning -- it's still in the morning phase. I thank you for your very detailed analysis that you gave us about the services and what you do, on a day-to-day basis, in taking care of these people. The questions we had and as our chairman referred to and so did Representative Demicco, what we have heard and we are not able to get our hands on to is, and I don't know if there's a threshold that when people are on the waiting list A, and they take help in one form or another, let's say a lump sum of X amount of dollars for whatever be the reason. That they are not -- they are not aware, the family is not aware at that time that because they took that amount of money, which they needed, that they are no longer on the waiting list at that particular time and that's we've heard over and over again. And as Chairman Ritter had alluded to, that when these people A, are these people taken off the list and B, if they are, are they aware of the fact that they're taken off the list, and do you have something in writing, from the family saying yes we are taking this money, at the same token we realize we're not going to be on the list anymore? And that is constantly something that is brought to us and the legislatures that this is what is happening. Or, that's the perception, at least.

COMMISSIONER MURRAY: I think -- thank you for that question. And I think that there is some confusion around that which also relates to the confusion of how we define the three lists that make up our waiting list, which we're in the process of hopefully correcting very quickly.

I testified that removal from the waiting list, occurs only under two circumstances. That would be an individual's residential needs are fully met so then that person obviously would be removed from the Residential Waiting List. Or, they are personally met through an allocation of more than $20,000, at which time they are moved to the other Residential Needs List. So they are still on our "waiting list" at large. They're not on the first priority you know, the first waiting list, which is the initial waiting list.

However, on other Residential Needs, we still -- we prioritize individuals as Emergencies or Priority 1. So, both of those lists, the Waiting List and the other Residential Needs List prioritize individuals as either an Emergency or a Priority 1, meaning their needs must be met within a year, theoretically if we can, if we have the resources. So there is nothing to say that they wouldn't be taken off that list, if their situation became an emergency. They are still there, they are still there in our PRAT database in the other Residential Needs list. We're still very aware of them, they're not removed in any way.

REP. RITTER (1ST): Thank you for that clarification, but that's not what we are hearing, and as you said, it's a miscommunication there. I mean, and that is where the idea of informing them and getting something in response back to you, back to these -- to the agency in a written form that they are aware, that when they took this money whatever the amount is, $20,000 and then $20,000 more, that they have now moved from A to B or B to C, which is not something that A, they understand number one, is what I'm gleaning from you. But they are told, by the people out in the field, a simple thing, that you're no longer on the list.

And so then maybe the -- it is at that point in time, you're not on that list, but you are on another list. You know that information somewhere, it's just a question of maybe proper communication so that these, the families don't feel that all of a sudden, that they are no longer on this list.

COMMISSIONER MURRAY: I completely agree. And I will say too, that I think there is an element of staff training here that we need to adhere to although that's an item that's been missing from our budget from some time but we still need to be doing staff training in terms of our communications regarding waiting lists and the different categories of waiting lists.

And also, what I really appreciate about this bill, and the issues that have been raised about this bill, is the fact that we do have a waiting list project underway with people from the Arc and family members and we will addressing these questions very explicitly to the satisfaction of everyone in the project. So this will be very helpful to us as we move forward.

And again, just to remind people, you know at DDS we have really moved into a mode of not wanting to linger on committees because of the severity and the urgency of the issues that face us. When we elevate something to a project, it's because we consider it to be somewhat urgent. I considered the waiting list, how we define it, how we communicate it to families to be urgent enough to elevate it to the status of a project, and it was instituted as such about 4-6 weeks ago and it has begun.

So we will be taking these questions to that, I'm sure that people that are members of that project will be bringing those questions to us as well. So we will definitely flush it out.

REP. SRINIVASAN (31ST): Thank you commissioner. And, what I've heard on keeping this conversation but slightly in a different direction -- is this waiting list. And as you said, and obviously it all depends on funding. I'm sure you and I, and all of us here in the building, would like to take care of all these 2009 people if we could. Unfortunately we cannot, given our restrictions.

But what I hear from families very frequently is this list, they're not on an emergency list but obviously they want to see their loved one settled before they pass away. I mean that's typically the scenario and unfortunately when they become an emergency and then you have to take care of them at that particular point, because the caretaker is no longer there.

But what I hear from the families is, that before it becomes an emergency, before that step has to be taken, this number, this numerical number on this waiting list, which is just a waiting list. I get that but the difference between somebody who got onto the list in 2010 and 2015, and they're not emergencies, but they would like to know that they are number 2000, or they're number 100, in all these lists on the non-emergency basis. Just for them to keep track of, as to what is happening and hope that we will have the funding to take care of their loved ones.

I know you have three lists, I'm well aware of that. I mean, from what you mentioned today. And I'm sure you're sharing that information with the families as well. But from what I heard from you is, other than the emergency there is no list other than just these names all, but not in any list form numerically.

COMMISSIONER MURRAY: That's correct. As you said, we don't have enough resources to care for all the people that have needs in our state. So the people that are on these lists, 2079 individuals that are on our waiting list, our other Residential Needs list, and our Planning List, all have various degrees of needs and acuity and personal situations, and ages, and caregivers and all of those things.

Many of them have supports in place but not enough. So, for us to assign and I really do empathize with families who would like to know what order are they in? When can we expect to hear something -- when? And, unfortunately the answer that we have to that is to do that would simply be to create false hope in people. And I say that as realistically as I can and as compassionately as I can because we do not have funding for new caseload right now. We do not have that any longer in the State of Connecticut. That is not possible for us. People come off of the waiting list, people come out of residential services for whatever reason. Sometimes they pass away, sometimes they come out of residential services for other reasons and we have spots that we can fill in. But there is not a lot of movement. There hasn't been a lot of change in terms of numbers over the past several years to be perfectly honest.

So I could tell somebody that you know on the Planning List the number 1053 and you know you got a long time to wait, you know and six months later their parents may not be in the picture and they may become an emergency and they go to the top of the line, you know. So it works both ways. You know they, we can't give them the you know -- the reassurance of knowing where they are in place, but at the same time given the circumstances it could change at any moment.

In terms of the really difficult situations for parents who are in their 60s or 70s and really wanting to see their adult children settled before they pass away, before they are incapacitated for caring for them. That is one of the most difficult circumstances that we face. That's why we were so grateful to $8,000,000 in new funding about 18 months ago from the final budged and we've used that. You know we've -- I can't even describe the work that has been done by our staff to find people in our state who are in need, who are most in need of those residential serves with caregivers age 70 and over.

In some cases I wish you know that we could have said 69 and over because we have people just missed the cut off. Or I talked to people today that are 69 today and about to turn 70 but if we don't have that new appropriation any longer. But that is, that is a dire need. That is something that we can only fill now on an emergency basis. We've been able to do it for 122 individuals from that 8 million, that's annualized, but that's all that we've be able to do for now.

REP. SRINIVASAN (31ST): Thank you commissioner, and my final question to you is, I'm sure you're familiar with the bill that we talked about in this committee in the previous public hearing, where money that's left behind in the department stays in the department -- stays in the agency and does not go into the general fund. So if that were to pass, would that help significantly this wait list that you, that you are referring to that people who are 69 and turning 70 and need to be assured that there is hope, that their adult child will be taken care of when they're still live?

COMMISSIONER MURRAY: Well, any additional resources would help. I'm not sure of any agency but we live in a state where money that is saved by a state agency goes back to the general fund. So I really can't take a position on that bill. In my position, I can simply state that yes, any additional resources would be very well used by our agency but we're not in a position to talk about that particular position.

REP. RITTER (1ST): Thank you commissioner. Thank you for your testimony. Thank you for all the hard and the good work that you do. We all appreciate it. Thank you.

COMMISSIONER MURRAY: Thank you very much.

REP. SRINIVASAN (31ST): Thank you Mr. Chair.

REP. RITTER (1ST): That was an impossible question for the commissioner to answer so, she did a good job on that. I mean again, it's a legislative priority and it's our job and we get it that more funding would be adequate. And we appreciate the sensitivity for you on that response. Representative McCarty of the 38th.

REP. MCCARTY (38TH): Thank you Mr. Chairman and welcome commissioner. And I would also like to say thank you very much for the detailed explanation about the waiting list and I think we're all here -- the genesis for this bill was due to that particular issue but I'm concerned on Section 3 and you commented that the individuals that may not be in compliance that have failed to work with the case manager. Can you just explain what happens to them? Can they come back again at some other point to return to receive services? I'm just confused about what happens to those individuals and how many are there, perhaps? Thank you.

COMMISSIONER MURRAY: Thank you for that question. I, I don't have an exact number. We can certainly get that for you I think. I think it would be a very small number to be perfectly honest. Because we work extremely hard to make sure that we don't lose people due to the fact that they've lost eligibility. But as I said, we have three people from DSS who actually sit right outside my office in cubicles and I know that -- I see them working all day long on their computers, working on re-determination and Medicaid eligibility.

So, we really go through a very detailed process with intervals in between to reach those people in writing and whatever way that we can to notify them that they are not in compliance with our Medicaid requirements so that we can have them enrolled in our Waiver which is a requirement to receive services under our Waiver Services at DDS.

So, can they come back, sure. I mean, they can come back but we work very hard to make sure, we don't lose them in the first place. I, I can't even begin to guess how many people that is. I think it's very small. I do think there is an issue around re-determination of Medicaid eligibility, that we could make simpler and we've had discussions with DSS and OPM about that, but really losing people for our system of supports is very rare.

We really -- what happens is that we spend a lot of time re-determining people. People whose status don't really change. That's something that we focus a lot of time on, and our providers do as well. Some of our providers are responsible for doing that for their residence.

REPRESENTATIVE MCCARTY (38TH): Thank you for that clarification and also for your willingness to work with this committee so that we can try to find the best solution. I think the common goal with all of us is to be sure that we're providing the best support and the best services that we can without adding extra administrative burden, but really trying to work out to the best of our ability for these individuals, so thank you for your commentary.

COMMISSIONER MURRAY: Thank you.

SENATOR GERRATANA (6TH): And thank you for indulging the committee too, commissioner we appreciate your being here today, and being so forth coming with so much information. We do -- we do appreciate that.

COMMISSIONER MURRAY: Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. We're going to go onto Deputy Commissioner Janet Brancifort and then we're going to start with the public, we're a little overdue there. And the first person in the public to testify will be Sandra Carbonari, Dr. Carbonari.

DEPUTY COMMISSIONER BRANCIFORT: Good morning Chairperson Gerratana and distinguished members f the Public Health Committee. I am Janet Brancifort, Deputy Commissioner of the Department of Public Health. I am here to testify today on the following Department of Health bill, Senate Bill No. 218, AN ACT CONCERNING THE DEPARTMENT OF HEALTH RECOMMENDATIONS FOR REVISIONS TO THE STATUTE REGARDING HUMAN IMMUNODEFICIENCY VIRUS.

SENATE BILL NO. 288, AN ACT CONCERNING THE DEPARTMENT OF HEALTH RECOMMENDATIONS ON THE EXPANSION AND CONSTRUCTION OF WATER SYSTEMS.

AND HOUSE BILL NO. 5451, AN ACT CONCERNING THE DEPARTMENT OF HEALTH RECOMMENDATIONS FOR VARIOUS REVISIONS TO THE OFFICE OF HEALTHCARE ACCESS STATUTES.

You have a copy of my testimony in front of you, so in the interest of saving time, I am only going to summarize of the department's bills.

Senate Bill No. 218, AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH RECOMMENDATIONS FOR REVISIONS TO THE STATUTES REGARDING HUMAN IMMUNODEFICIENCY VIRUS makes technical changes and updates to the HIV statutes to conform with current public health practice and guidelines, such as the National HIV AIDS Strategy. Many of the statutes related to HIV haven't been reviewed and revised since the 1990s. Section 1 make recommended changes to include providing the needle exchange statute to include towns where hepatitis C is also prevalent, which will ensure needle exchange services are not just limited to those cities with the highest number of HIV but also include cities with high number of hepatitis C. Along with expanding the services provided by the needle exchange program to include overdose prevention education and access to Naloxone. Hepatitis C education and testing, removing the cap of 30 syringes and revising evaluation requirements to align with the current Department of Public Health contact requirements.

Sections 2 and 3, revises Section 19A-581 and 19A-582 regarding AIDS testing and medical information to add a definition for community based HIV testing provider, which is an individual organization that conducts HIV testing in a non-clinical setting along with allowing a community based HIV testing provider to obtain verbal consent rather than written consent when completing testing in the field.

It should be noted that the provider will document the verbal consent on the CBC/HIV test form prior to completing the test. But the consent will no longer need to be a separate document.

Section 4 and 5 make technical changes such as changing AIDs to human immunodeficiency virus.

Section Bill -- I'm sorry, Senate Bill No. 288, AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH RECOMMENDATIONS ON THE EXPANSION AND CONSTRUCTION

OF WATER SYSTEMS, construction of water systems provided the application process for reviewing a certificate of public convenience and necessity, CPCN. The department worked with the public utilities regulatory authority to come up with a plan that will expedite the CPC and application process. The department will continue to evaluate the safety and adequacy of the source of water supply and ensure that the construction of a new water system needs engineering guidelines. PURA will conduct a final half of the review of the proposed system that are regulated by PURA or when the ownership is not being assigned to an exclusive service area provider. This will ensure that both agencies are not duplicating efforts but still maintain the integrity of the process to issue a CPCN.

And finally House Bill No. 5451, AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH RECOMMENDATIONS FOR VARIOUS REVISIONS TO THE OFFICE OF HEALTHCARE ACCESS STATUTE TO MAKE TECHNICAL CHANGES TO THE DEPARTMENT OF PUBLIC HEALTH OFFICE OF HEALTHCARE ACCESS STATUTE.

Section 1 and 2, will revise the current payment process for consultants hired by the office of Healthcare Access to assist in the analysis of certain Certificate of Need applications or to conduct a cost in market impact review with a Certificate of Need application involves the transfer of ownership of a hospital.

Sections 3 and 4, make technical changes to clarify and simplify language included in Public Act 15-146, regarding the replacement of imaging equipment.

Section 5 will eliminate and expire date by which OCHA is required to adopt final regulations.

Section 6, proposes a change to specify that the notice to patients regarding the imposition of facility phase should be worded in a general manner and not specify any individual patient.

Section 7, seeks to clarify the filing of annual facility fee information required by 19A-508C.

Section 8, addresses facility fee information by changing the reporting date for hospitals currently due January 1st to January 15th. Since Hospitals report on the calendar year lengthening the late fee period from 5 to 7 days for hospitals.

Section 9, lengthens the 2 percent late fee period from 5 to 7 days in order to provide help an increase in time to provide notification to hospital who have not remitted their payment by the assessment due date.

Section 11, removes the mandate that OCHA develop an inventory questionnaire to obtain certain information. Instead the proposed change allows OCHA more flexibility and the form being used to collect the information without actually eliminating the task of collecting the information.

Finally, Section 12 removes the word willfully and revises it to negligently. Over the past several years, OCHA has issued several notices of it's intent to impose a civil penalties for the failure of a healthier facility to file a Certificate of Need. These matters have come before OCHA for hearing purposes and each time the civil penalty was waived due to OCHA's inability to establish a willful motive on the part of the healthcare facility. It has been OCHA's experience that a healthcare facility can overcome the willful standard by simply stating under oath that it did not intend to usurp the Certificate of Need process.

I would like to think the Public Health Committee for raising the department's bills and I look forward to working with as I move through the legislative process. The DPH staff and I are available to answer any questions you may have.

SENATOR GERRATANA (6TH): Thank you so much for your testimony today. We do appreciate it. Does anyone have any questions? Yes, Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you deputy commissioner for being here this afternoon. On the first bill, Bill No. 218, you mention that one of the suggestions or requests was to switch the written authorization to a verbal authorization, and what would be the reason that we would not want to continue with the written request as opposed to the verbal one?

DEPUTY COMMISSIONER BRANCIFORT: We're looking at trying to reduce the barriers and obtaining consent, and there's been recommendations to -- actually to look toward moving to a verbal consent. There are about nine other states that have moved forward in that direction already and both Massachusetts, well Massachusetts, Rhode Island and New York have already moved to that option.

So then if a person is a non-traditional setting and where someone may be doing some community based screening or outreach, that they can just obtain the verbal consent at that time, they would still be completing the CDC documentation for consent, again just to reduce some of the barriers that still are associated with obtaining consent for testing.

REP. SRINIVASAN (31ST): So in looking at this barrier that exist in these other states and what you are recommending and suggesting to us is that when the consent is moved from written to verbal there's a higher incidence of getting the consent, is that the idea that you are able to achieve that?

DEPUTY COMMISSIONER BRANCIFORT: Yes, that's correct.

REP. SRINIVASAN (31ST): And these would only apply to non-traditional settings?

DEPUTY COMMISSIONER BRANCIFORT: That's my understanding.

REP. SRINIVASAN (31ST): Thank you Deputy Commissioner. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you, are there any other questions or comments? If not, thank you so much for coming today and giving your testimony, we appreciate it.

DEPUTY COMMISSIONER BRANCIFORT: Thank you.

SENATOR GERRATANA (6TH): Next is Dr. Sandra Carbonari to be followed by First Selectman Susan Bransfield of the town of Portland.

SANDRA CARBONARI: Good morning.

SENATOR GERRATANA (6TH): Good morning Dr. Carbonari, thanks for coming today.

SANDRA CARBONARI: Thanks for giving me the opportunity. My name is Sandy Carbonari and I'm a primary care pediatrician and the immediate past president of the Connecticut Chapter of the American Academy of Pediatrics. I'm here representing the nearly 1000 members of the Connecticut AAP. We are in support of House Bill No. 5450, AN ACT CONCERNING THE USE OF PALLIATIVE MARIJUANA.

We support passage of this bill as written. The American Academy of Pediatrics opposes the use of medical marijuana outside the regulatory process of the US Food and Drug Administration, because there are currently no published studies on the efficacy of marijuana as a medication in children.

Additionally there are grave concerns about the effect of marijuana on the developing brain. However, we in Connecticut recognize the potential for use in cases of children with terminal illness or debilitating conditions such as intractable seizure disorders that cannot respond to traditional treatment modalities

In these situations, the benefit of potential relief of pain and suffering outweighs concerns about future brain development. Marijuana is classified as a schedule one drug by the US Drug Enforcement agencies, signifying the drug has high potential for abuse, no accepted medical use and there is a lack of accepted safety for use of the drug or substance under medical supervision.

Cannabinoids, which are components of marijuana have been proven to be effected in treating specific conditions in adults including nausea, vomiting and chronic pain. Currently, there are three pharmaceutical cannabinoids approved. However there have been no published studies about the effects of cannabinoids on the pediatric population and developing brain.

The AAP strongly supports research and development of pharmaceutical cannabinoids and supports review of policies promoting research on the medical use of these compounds, and we recommend changing marijuana from a DEA Agency Schedule 1, to a Schedule 2 drug to facilitate this. We strongly support the requirement that a Board certified pediatrician be on the Board of Physicians that reviews the addition of new conditions qualifying for use of palliative marijuana. In fact, we currently have three members who are interested and highly qualified to serve.

Additionally, we believe the section which will allow for bifurcated decision making is good policy. This will allow for making decisions for future adult conditions separate from that of children's conditions, and within that frame development must be considered.

The AP has a policy statement, a full technical report and in my written testimony, I've supplied the link to both of those. If I have another minute, I just want to mention that we have submitted written testimony on three other bills, today.

SENATOR GERRATANA (6TH): Okay, so you have testimony on the three other bills, also?

SANDRA CARBONARI: I submitted written testimony. I don't have to --

SENATOR GERRATANA (6TH): Oh, just written testimony?

SANDRA CARBONARI: Yes, that's why I mentioned that.

SENATOR GERRATANA (6TH): Sure, no that's fine. That's very good. Thank you very much for coming and testifying on this one. We do appreciate that and we'll read your other testimony. Are there any questions? If not, thank you so much.

SANDRA CARBONARI: Thank you.

SENATOR GERRATANA (6TH): Next is First Selectperson Susan Bransfield followed by Robert Fiore.

SUSAN BRANSFIELD: Hello Madam Chairwoman and thank you for --

SENATOR GERRATANA (6TH): Hello.

SUSAN BRANSFIELD: -- having me. I'm here today to testify on H.B. 5457, AN ACT CONCERNING OUR LOCAL HEALTH DISTRICTS AND HEALTH DIRECTORS. My name is Susan Bransfield, and since 2003 I've been serving as the First Selectwoman of the Town of Portland. And I also note I am a member of the Board of Directors of the Chatham Health District. The District serves the towns of Portland, East Hampton, East Chatham, Colcester, Marlborough, Hebron and Haddam. And I will note that Haddam has voted to leave the District effective July 1, 2016.

I must first stress that I am representing my opinion only. And I am testifying in support of H.B. 5457 and I wish to voice my strong support of additional oversight of health district. I'd like to share a brief review of a recent situation that has occurred.

In 2015 the State Public Health Department expressed great concern with the work performs of the Chatham Health District's Director of Health. In the department scheduled hearing concerning his work performance. The performance issues had allegedly been occurring for many years and while I'm unclear as to how the State Department of Health became aware of the issues, I do know that they did notify the local district of its concerns with our health director. The performance issues involved the director allegedly having another income producing job, while serving as a full time Director of Health for Chatham Health. He had allegedly misused State Health laboratory resources and the director did retire from the Chatham Health District in December of 2015.

There is reported to be a state settlement agreement with the former director and as I understand it, he may no longer work in Connecticut as a director of health and can never again be compensated for any work using State Health Department funds. I also understand that the state must be paid back for the money it as allegedly owed.

In my opinion the health district model of towns joining together, is a good one. And it can be efficient and very effective for providing quality public health services to our residents. However as with any operation of government, health districts require proper planning, proper assessment and oversight to be successful.

So I request that you endorse the concepts presented in H.B. 5457 and that you make appropriate changes to strengthen the oversight of local health districts. Thank you.

SENATOR GERRATANA (6TH): And thank you for your testimony. Representative Carpino, has a comment or question.

SUSAN BRANSFIELD: Thank you.

REP. CARPINO (32ND): Susan thank you for coming up, thank you Madam Chair. And thank you for telling the story of the Chatham Health District, I've explained it to some of my colleagues but from you it's -- I think it is a bit more pointed and so you can share your perspective. My question to you is pretty specific, do you think this line will make enough of a difference to help Portland and our residents that were really dealing the brunt of these allegations, at this point? Or would you like to see us go further?

SUSAN BRANSFIELD: Well, I think it's a good start Representative Carpino, and I think that you want to proceed cautiously and make sure that there in not onerous regulations but rather regulations that are helpful toward making sure that the integrity of how districts are operated is maintained.

REP. CARPINO (32ND): Thank you and as you know me personally I don't want to unduly burden anybody, particularly the local districts but I want to make sure that you have the support you need. We're talking about a health district. My Portland residents need to make sure that the integrity of that health district is clear so thank you for coming up here. Thank you for doing what you've done so far to come to the aid of our Portland residents as part of the district and I will keep you posted as to the progress.

SUSAN BRANSFIELD: I appreciate you helping us so much. Thank you very much Representative Carpino and thank you again Madam Chairwoman.

SENATOR GERRATANA (6TH): And thank you so much for coming up and sharing with us your concerns we do appreciate that very much.

SUSAN BRANSFIELD: Thank you for all your work.

SENATOR GERRATANA (6TH): And your patience, too.

SUSAN BRANSFIELD: Okay.

SENATOR GERRATANA (6TH): Thank you. Let's see, we have Robert Fiore and following Robert is Senator May Flexer. Oh that's quite alright, we can go, we can go back to him. I don't know if Senator Flexer is here, I don't see her in the room. So then we'll go to Dwayne Paul, I believe. Yes, Dwayne Paul and we'll come back to Senator Flexer or then go onto Representative Brian Becker. Mr. Paul.

DWAYNE PAUL: I'm from Hampton, Connecticut and I am here in support of House Bill No. 5450. I'm the father of a 25 year old daughter who was first diagnosed with epilepsy 17 years ago. Having to look back on that, I say 17 years my gosh, where has the time gone? Since that time I've served as a board member for the Epilepsy Foundation of Connecticut as well as on the Council of Developmental Disabilities and I have had the great fortune to meet many, many people that are afflicted with epilepsy. Some have been very brave individuals and responded well to medications and others have not.

Part of the challenge we have is that fully one third of patients in Connecticut have what's called medical refractory epilepsy, which means there is no known cure or treatment to effectively control their seizures. One third, in Connecticut that's more than 20,000. My daughter is unfortunately among that one third. This brings us to part of the problem which is that current traditional medical treatment is flawed. As you have heard in previous testimony, folks have tried multiple medications as well as different surgeries have not helped. My daughter is one of those.

Anything that gives us the hope of controlling or minimizing seizures we try, so we tried different medications singularly and in combination. In my daughter's situation we tried 30 different medications. None of them have worked. We've also tried brain surgery and that didn't work. And why do we try? We tried because of hope. We set aside the significant side effects that can occur with these medications. Such as hallucinations, severe weight loss, severe weight gain, behavioral disorders, cognitive functioning disabilities. All in the hopes that something with traditional, current medical technology will help solve the seizures.

And that's part of what brings us here today, is this House Bill No. 5450. There is new hope, it is hope that has been met with positive results in other states in this country. Hope that is advocated for by the Connecticut Chapter of the Academy of Pediatrics and hope that a new treatment may positively affect the lives of thousands of Connecticut residents.

A pretty well known doctor, from a pretty well known hospital in the State of Connecticut recently said to me, you know Mr. Paul maybe you just have to accept the fact that your dad's seizures aren't going to get better. To which I replied, no sir, I'm not going to. Not as long as there's hope. So we keep trying different things. Now, I ask you to consider this new treatment and if it can benefit one person, wouldn't it be worth it. If it can improve the lives of hundreds of people so that they can live what we would consider a traditional, normal life, wouldn't that be worth it. I think so.

You have the opportunity here to help thousands of Connecticut residents have hope. I respectfully request your unwavering support of this bill.

I want to thank you again for your time, and consideration. I'll be happy to answer any questions

SENATOR GERRATANA (6TH): And thank you sir. Thank you for coming today and giving your testimony. We do appreciate it. And I don't think there are any questions at this time, but thank you for, for coming today.

DWAYNE PAUL: Thank you for having me.

SENATOR GERRATANA (6TH): You're welcome. Next is Senator Mae Flexer. And when Mr. Fiore comes back, just let me know and we'll get back to him if someone can just let me know, thank you. Good afternoon.

SENATOR FLEXER (29TH): Good afternoon Senator Gerratana, Representative Ritter and distinguished members of the Public Health Committee. My name is Mae Flexer I'm lucky to serve as the State Senator for the 29th State Senate District, and I thank you for the opportunity to speak today in support of Senate Bill No. 290, AN ACT CONCERNING THE SALE AND PURCHASE OF TOBACCO PRODUCTS, ELECTRONIC NICOTINE DELIVERY SYSTEMS, VAPOR PRODUCTS AND SIGNAGE CONCERNING THE USE OF SUCH PRODUCTS AND SYSTEMS.

I want to think the committee for raising this bill, it addresses what I believe is a critically important issue. I'm here today with Bob Brex, and I'm also proud to serve on their Board of directors.

As you know tobacco use causes some of the most prevalent and yet preventable health issues in the State of Connecticut. Cancer, chronic emphysema, asthma and even type 2 diabetes. They are all caused by the consumption of tobacco products. The Surgeon General reports that the number one cause of death in the United States and Connecticut is heart disease. And the leading cause of heart disease, is smoking. The Connecticut Department of Public Health estimates that 4300 adults die each year from smoking and that does not include individuals that are affected by second hand smoke. DPH also estimates that Connecticut spends 1.4 billion dollars annually on smoking related issues. Of that spending Connecticut taxpayers contribute over $300,000,000. If Connecticut thanks it's increasing difficult budget challenges it's clear that we should be taking a hard look at ways to prevent smoking and drastically lower rates of usage.

According to DPH, nearly 90 percent of adult smokers will start smoking at or before the age of 18 Of that 90 percent, about half of those start using tobacco before the age of 16. The Centers for Disease Control report that more than one third of those who start smoking before the age of 18, will become regular daily smokers before leaving high school. The same trends have also been found in those that chew tobacco products and use other tobacco products.

Research conducted by the CDC suggests that the number of children buying tobacco products from their peers who are at least 18 years old, doubled from 2001 to 2009. While he numbers of those buying directly from the store, has been cut from 38.7 percent to 18.7 percent in the past decade. That's a reduction of more than 50 percent.

It's clear then, that children and students are now more likely to receive tobacco products from their older peers. By raising the minimum age to purchase tobacco products, we have the opportunity effectively eliminate a major route utilized by young adults to obtain tobacco products.

Gaps and Youth Access restrictions are problematic because they undermine the potentially large health benefits that reduce usage. Research conducted at the University of California Irvine, suggests that the long-term population health benefits of decreasing youth smoking initiation are seven times greater than those resulting from comparable improvement in adult cessation.

To be clear, this does not mean that cessation programs are neither beneficial north crucial to improve public health, but it's widely known that avoiding smoking is easier than quitting. It can take the average of seven attempts before quitting smoking is successful. If youth access to tobacco can be restricted, it will provide direct health benefits to those who do not initiate smoking. And allows cessation programs to better serve the individuals who need it most.

Raising the minimum age of tobacco products will improve public health, ensure the safety well being and longevity of all Connecticut residents.

I thank you very much. I think the committee for raising this bill and addressing this critical public health issue. And I thank you for your consideration.

SENATOR GERRATANA (6TH): Yes, please proceed.

BOB BREX: Good morning.

SENATOR GERRATANA (6TH): Good morning.

BOB BREX: Senator Gerratana, Representative Ritter and members of the Public Health Committee, my name is Bob Brex, and I am testifying in support of S.B. 290, AN ACT CONCERNING THE SALE AND PURCHASE OF TOBACCO PRODUCTS, ELECTRONIC NICOTINE DELIVERY SYSTEMS AND VAPOR PRODUCTS, WHICH WOULD RAISE THE AGE FOR THE PURCHASE OF TOBACCO AND NICOTINE DELIVERY SYSTEMS TO 21.

I hear represented a Connecticut Prevention Network, which is the Association of the Regional Actin Councils in the state. CP and the Regional Action Council have a long history of supporting efforts to prevent our young people from future addiction to tobacco and other tobacco and nicotine products.

The Regional Action Councils were original members of mobilizing against tobacco for children's health and worked to remove smoking accommodations many years ago.

As of February 2016, 121 cities and 9 states and the entire state of Hawaii have taken the step to raise the purchase age to 21. This covers over 14.6 million people. Popular support for raising the age, is present with the Center for Disease Control finding that in the July of 2015 study that 75 percent of adults, 70 percent of current smokers and 65 percent of those ages 18 to 24, support raising the age to purchase.

In Connecticut, about 3 percent of middle school and 20 percent of high school students use some form of tobacco in the past 30 days, and an estimated 56,000 children alive today will ultimately die prematurely from smoking related diseases.

In addition from 2011 to 2013 current E-cigarettes use more than doubled amongst high school students. According to Tobacco21.org, teen smoking is not so much powered by illegal sales, as it is to legal sales to older youth. Raising access to age 21, would put legal purchases outside of the social circle of most high school students. The Institute of Medicine in March 2015 released a report projecting the benefits of a nationwide Tobacco 21 policy. They found the results to be a 25 percent drop new smoking initiation a 12 percent drop in overall smoking rates and 16,000 preterm birth and low birth weight deliveries averted in the first five years of the change. Their conservative estimate is that if age 21 purchase was adopted throughout the US it would prevent 4.2 millions years of life lost to smoke with kids alive today.

I do not feel the need to tell you the health implications of smoking. But I will share one statistic from the American Lung Association that each pack of cigarettes consumed costs our society 18.5 excuse me, $18.05 increased health care and work related expenditures. This statistic clearly shows that whatever tax benefits the state may receive from the sales of these products is lost to the long-term health effects.

As a preventionist, I know that delaying the age of onset to use helps protect many more young people from eventual addiction. By increasing the age of purchase to 21, it will reduce initiation in younger youth.

Again, I support S.B. 290 and would be pleased to answer any questions you may have on this subject. Thank you.

SENATOR GERRATANA (6TH): And thank you. Thank you both for coming and testifying today. Are there any questions? Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Senator Flexer and thank you for coming here this afternoon and testifying. Just two questions if I may. Can you tell us the other states in the nation that have now moved the date of purchase from 18 to 21?

SENATOR FLEXER (29TH): Right now it is the state of Hawaii and there are other municipalities, 9 cities. Excuse me, 121 cities and 9 states and the entire state of Hawaii have moved the age to 21.

REP. SRINIVASAN (31ST): I'm sorry, I couldn't hear you clearly.

SENATOR FLEXER (29TH): One state, Hawaii and there's 121 cities and nine different states that have moved the age to 21 as well.

REP. SRINIVASAN (31ST): Thank you, and would this apply not only to cigarettes but to E-cigarettes as well?

SENATOR FLEXER (29TH): Yes it would apply to all tobacco related products including E-cigarettes.

REP. SRINIVASAN (31ST): Think you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. And again thank you both for coming today and providing your testimony, we do appreciate it. Oh who else? Oh, Representative Genga, I'm sorry.

REP. GENGA (10TH): Thank you. Thank you Madam Chair. Thank you for your testimony. It was very interesting and very factual and informative. One of the questions I've been asked and it's a dilemma here, if we allow young people at the age of 18 and consider them adults to make a choice about going into the military or not, how do we justify not allowing them to make this choice?

SENATOR FLEXER (29TH): Well thank you representative for that question and on a side note I want to thank you for your leadership in trying to protect young children from the effects of tobacco. That's an issue that I've grappled with, I'm the Chair on the Veterans Affairs Committee so being cognizant of the fact the sacrifice and service of our members of the military is really important to me. I think it should be consistent with alcohol use, if we've made a decision as a society to have that age be 21 then tobacco products should be the same way, given the dramatic health effects that tobacco use has on our young people and have on them throughout the duration of there life.

REP. GENGA (10TH): Thank you, well put.

SENATOR GERRATANA (6TH): Thank you. I don't think there are any more questions, so. Thank you again both of you for coming.

SENATOR FLEXER (29TH): Thank you very much.

SENATOR GERRATANA (6TH): Let see, we have Dr. Frank Castiglione, followed by Representative Bryan Becker, followed by I think it's Marghie Giuliano followed by Representative Stanski, sorry -- Staneski, sorry. Welcome.

FRANK CASTIGLIONE: Thank you, thank you. Good afternoon Senator Gerratana and Representative Ritter and distinguished members of the Public Health Committee. My name is Frank Castiglione, Jr. M.D., I'm a Board certified dermatologist, practicing in Hamden. I'm also the Present of Connecticut Dermatology Society. I'm here on behalf of over 1000 physicians in the above mentioned specialty offering you testimony opposing RB 5450, AN ACT CONCERNING THE USE OF MARIJUANA.

I'm here in opposition for several reasons RB 5450 is flawed by the establishment of a medical board that may add debilitating medical conditions, but is not given latitude to subtract conditions that are deemed to be no longer debilitating or for which marijuana was found to have little real benefit.

Medical science continues to progress at a rapid pace and can be expected to provide treatments for many diseases presently regarded debilitating. The law wisely provides for research into the effects and uses of marijuana, but will only allow the Board to act on some of that data. If the research allowed finds no significant efficacy from marijuana on an approved condition that condition cannot be rescinded as the law is currently worded.

We applaud the addition of the pediatrician to the Board of Physicians and the requirement that they be chosen in consultation with the Connecticut Chapter of their specialty society. But would suggest that level of -- be extended to the other seven members of that Board who should also be chose in consultation with their specialty group or the Connecticut State Medical Society as an umbrella group for all physicians and surgeons.

And we question why the current language requiring expertise in relevant fields of medicine is excised from the language rather than simply adding pediatrics to the list. These physicians and surgeons have a very important job and should be carefully chosen and highly qualified. We also have concerns about placing oversight and definition of portions of medical practice under the Department of Consumer Protection rather than the Department of Public Health. This duplication fractures the governance of medical practice in the state and could create conflicts that might impact care and the safety and health of patients.

Finally we oppose 5450 because it continues to put glaucoma in the list of conditions for which marijuana may be used for the palliation of a debilitating medical conditions. Our concerns specifically is with regard to listing glaucoma, a condition that is rarely debilitating and it is not responsive to any palliative impact that has been attributed to marijuana. Palliative use as defined in the bill quote means, to alleviate a qualifying patient symptoms or the effect of such symptoms." Loss of vision, the primary symptom that occurs with glaucoma does not abate in response to marijuana so there is no opportunity to use it for a palliative effect. As such, it does not meet the criteria for inclusion under provisions of the bill and should be removed from the list of covered conditions.

According to our ophthalmology colleagues the only eye effect attributed to marijuana is an extremely weak and short-lived pressure lower effect that while not harmful, is hardly helpful in light of the significant uncertainty entailed in using an inhaled chemical with inherent inconsistency and quality and quantity of effect.

No ophthalmologist would ever prescribe an eye drop that had so weak or short-lived an effect. The pressure lowering effect of cannabis is so unreliable that even if it had no side effects at all, it would not support a case for the use of marijuana.

Inhaled marijuana is a regressive treatment because it requires the entire body to be subject to the pharmacologic effects of the drug. Whereas the topical application of eye drops concentrates the effects of the drug on the one organ where it is needed, the eye. Limiting systemic exposure.

We ask that the committee remove glaucoma from the list of conditions qualifying for medical marijuana. This opinion is supported by the American Academy of Ophthalmology and by the National Eye Institute.

In closing without at the scientific studies supporting the use of marijuana as a palliative effect agent for glaucoma, and because the previously mentioned additional flaws in the bill we cannot support 5450.

We understand and we empathize with patients who may be desperate for relief of pain and who envision the use of marijuana will relieve symptoms. Our job is to ensure that the therapies made available and promoted by the state are proven to be safe and effective and therefore urge you to vote against the bill.

We'd like to bring patients -- like to have the patient stay within the medical home through the Public Health Department. And I am happy to answer further questions you might have. I apologize for the structure, we are not against the palliative effects of marijuana, generally.

SENATOR GERRATANA (6TH): I see, okay. I just wanted a little bit of clarification and I thank you for coming and giving testimony today. You can't support 5450 but in some cases you're not really addressing the changes in language in that bill but you are rather referring to, there's one case, the change of language regarding those who would be on the Board of Physicians, you're concerned about.

FRANK CASTIGLIONE: Right.

SENATOR GERRATANA (6TH): And we're not proposing I don't believe, I'd have to go back and read it, but I don't think with the -- currently, let me rephrase this. Currently under law we have glaucoma listed as one of the conditions that would be debilitating enough that you would need medical marijuana. Generally speaking children don't develop glaucoma from what I know or have heard. So actually, I guess my question goes to, you'd rather us go back and look at some of those conditions and beef up that Board and keep those qualifications in there or something along that line. And let them have the kind of input that is responsive if you will to the day-to-day and the science and you know what is out there. And of course we know there is not an awful lot of data scientific data regarding the use of medical marijuana in fact, were just starting to do that, and the bill does address that in talking about research that can be done also, which could put us in the forefront. You know as a state that is actually addressing I think, a very serious issue of a dearth of information about the efficacy and the use of marijuana in our pharmacopeia.

So I just want to be sure that I understand that your commenting on the law as is, are you opposed -- are you totally opposed to the use of medical marijuana as the -- outlined in the bill for children?

FRANK CASTIGLIONE: No, not at all.

SENATOR GERRATANA (6TH): Okay, just wanted to make sure we're clear on that.

FRANK CASTIGLIONE: And I think we need to make sure that the specialty physicians that are on Board, are the very best who are vetted by our medical society.

SENATOR GERRATANA (6TH): And then I'll come back at you, there are you know, and I think we have a very good model going in this state on medical marijuana, and I said it publically that you know other states are looking at it as a way to also configure their programs. But you know the challenge has been finding physicians who fit the definitions that we have in statute for the Board of Physicians to sit on the Board. This is a lot of work of course and those individuals have not been forthcoming so DCP has quite a challenge there.

FRANK CASTIGLIONE: Hopefully our societies can help work things out and give the right names and have the right amount of volunteerism.

SENATOR GERRATANA (6TH): Thank you. I have a seasonal thing and you know. Well thank you for that, because I think they could use that help and input and if societies would find individuals who are willing to serve. I'm sure DCP would be very happy to have them, but I think that's one of the challenges that we have.

Are there any other questions? Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you very much for your testimony this afternoon. So, continuing the conversation that was just started by our chairwoman, so you are not in opposition of the use of palliative marijuana for children?

FRANK CASTIGLIONE: That is correct.

REP. SRINIVASAN (31ST): Thank you. And so you're asking us to look at the Board, the way is formulated A, get competent physicians to serve on the Board, and then revisit the various conditions that have already been approved and see which of those may have to protracted?

FRANK CASTIGLIONE: Absolutely, yes that's correct. Additionally, we have the concept of who governs that Board. Is it going to be through the Department of Public Health or the Consumer Protection Department? We thought that perhaps as part of this medical family we would point towards the public health department.

REP. SRINIVASAN (31ST): Thank you for your testimony. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Representative Candelaria.

REP. CANDELARIA (95TH): Thank you Madam Chair and thank you for your testimony. We had this issue with the Board come up in our regulations review committee last week. When medical marijuana was first passed, we established this Board of eight doctors that are supposed to be making recommendations to expand possibly the uses for medical marijuana. And what we found is that adhere has only been four doctors currently appointed to the Board so it's not even fully constituted. Yet the Board anyway and made recommendations to expand.

One of those recommendations actually didn't pass by majority vote, yet it came before our regulations review committee anyway. I think that certainly we're hearing testimony today that there is value potentially for the use of medical marijuana and I think so far we've done a pretty good job with the model that we've created but in it's application right now, to me, sitting in regulations review, it felt like we're getting into the wild west a little bit, where if voices loudly advocate for a certain illness to be treated, it's going to end up on the list, and it's going to get treated even if there's not any evidence that it could help that illness and in some situations it could actually be more detrimental to the illness. And so we're not making that evaluation.

So I, I appreciate your testimony in regard to maybe having this Board continue to review not just new illnesses but the ones that are currently on there, because this underlying bill, which I think is important for us to adopt incorporates the research piece that we need in order to make the gains to treat illnesses like epilepsy, you know with marijuana.

My question for you is, with this Board aside from having maybe the physicians and the pediatricians on the Board, what would you think about also maybe trying to incorporate some people in a drug addiction specialist as well to sort of give the other side because they see people on the back end and maybe could see where if somebody for instance had PTSD has a medical marijuana card, ends up going in a bad direction. Ends up getting treatment, they have that data to see could this drug be hurting certain people that we're meaning to treat, and to improve their lives.

FRANK CASTIGLIONE: I think that's an excellent idea. I think that's a fluid situation. The research as you say hasn't been done, is being done. These are people who are working in the field as long as they have some sort of expertise that they will be able to be objective and you know knowledgeable; I think that would be very helpful.

REP. CANDELARIA (95TH): And also your comments on the illness. I think as I read the bill and I don't know if you read this the same way, so that illnesses that we have enumerated in this bill, as written would also automatically translate to children as well so, we're lumping all ages from 0 to 99 into one category.

Would you support maybe we should be bifurcating it and treating each differently?

FRANK CASTIGLIONE: Well I'm glad there's a pediatrician on the Board, think that's very helpful and I think in that situation I would defer to the pediatric specialist -- the pediatric person who is knowledgeable about that.

REP. CANDELARIA (95TH): Thank you. I appreciate those answers. Because I think this has been a difficult issue for some of us or many of us. But I think that there is lot of merit to what potentially we could do for the State of Connecticut in developing the research and the laboratory testing on this. I think if we tighten up the language within this bill, we can get probably near unanimous support from the various interest groups.

FRANK CASTIGLIONE: I think it would be a positive end point.

REP. CANDELARIA (95TH): Thank you.

SENATOR GERRATANA (6TH): Thank you. Representative Sayers.

REP. SAYERS (60TH): Are you aware of any studies that have been done on children for the diseases identified in this bill?

FRANK CASTIGLIONE: No I don't.

REP. SAYERS (60TH): Do you have a problem with research being done on children?

FRANK CASTIGLIONE: Not at all, as long as they're done within the realm of what's considered appropriate for research, absolutely yes.

REP. SAYERS (60TH): And in most drug situations they don't do research on children?

FRANK CASTIGLIONE: I have no idea. That's beyond my fund of knowledge.

REP. SAYERS (60TH): Well they don't usually do research on children. It's one of the problems we have when prescribing especially like things like in behavioral health drugs for children. But there isn't research out there, just because the idea of doing research on children in that sense is kind of not.

FRANK CASTIGLIONE: Absolutely.

REP. SAYERS (60TH): So, thank you.

SENATOR GERRATANA (6TH): Think you. And thank you Dr. Castiglione for testifying today. Representative Brian Becker is on deck. Robert Fiore, are you back? Yes, you're up after Representative Becker, thank you.

REP. BECKER (19TH): Thank you Madam Chair, and members as well. -- thank you member Srinivasan and the distinguished members of the Public Health Committee. Thank you for taking the time to hear testimony on raised Bill No. 295, AN ACT CONCERNING RADIOLOGICAL AND IMAGING SERVICES.

Six dollars for a chest x-ray, think about that. It cost the medical office more than six dollars just to send the bill for the x-ray. Yet this is now the reimbursement amount that radiologist receives for providing a chest x-ray to Medicaid patients. It's no wonder then that we've seen two radiological offices in Hartford close recently. Radiologist warned that this would happen if in fact, DSS cut the reimbursement rate by a whopping 42 percent, and now it has.

This was first brought to my attention by a group of doctors last Spring late in our session, it was at night and I stepped out of the House Chamber and a group of doctors from my district who were making the point that they were being treated differently than any other specialty of a like kind.

And what I mean by that is a specialty whose reimbursement is broken down into different fee component. The professional fee and the technical fee, the equipment aspect of it. And the radiologist were seeking to be treated equitably with these other specialties, and I sought to help them. So we met with legislative leaders at the time, and thought that the problems would be fixed in the budget, they were not. We continued to press our case and thought it would be addressed and in the implementer, it was not.

And on the day after our June session on the implementers, still bleary eyed, I went to DSS with the radiologists and sat in a meeting with them to make the case for equitable treatment of the radiologists. And the radiologists had explained that they had painstakingly reviewed many medical reimbursement codes and could demonstrate how they were being treated differently and being singled out for this extreme reimbursement deduction.

DSS agreed to review the radiologist work in a meeting the following week and at that meeting, the DSS officials acknowledged that the radiologists were correct and thanked them for pointing out the discrepancy, but then instead of raising the rate of radiologist they chose to lower the rate of everybody else's down to that level, and that's just not sustainable. So as a result there is now reduced access to radiological services for Medicaid patients.

The bill before you would have the commissioner of public health determine how much that access has been reduced and report back to this committee. You got to consider amending that bill to not only have the study cover the how much the access has been reduced, but also the effects that reduction has had on our population. Because obviously we reducing access to healthcare specialties for low income patients should be a concern of ours.

Connecticut has a very high quality of life, and in fact we have a top ranking when it comes to our population's health. And I think you would agree, we should do everything we can to keep it that way. Thank you for your time and attention.

SENATOR GERRATANA (6TH): And thank you for our testimony. I recall those discussions too. Of course you know this is Medicaid rate setting that we're talking about and you know there's challenges right across the board, you know with that. But by in large the system has been working you know very well. Just saying an offhand comment, you know being Chair of the Medical Assistance Program Oversight Council, we hear from DSS consistently, but the bottom here is the bottom line you know it's related to the budget. But, I think you very much. You were very thorough.

Are there any comments or questions -- Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you representative Becker for your testimony this afternoon and bringing before us the impact of what as you gave as an example of what a chest x-ray, you know what they're reimbursed and as you appropriately said, what it even costs to send out the bill to over -- is leading Is this only for chest x-rays that you've seen in your discussions with the radiologists, or is it across the board all the other services as well.

REP. BECKER (19TH): So my understanding is, it's across the board but you'll have an opportunity I know that there should be I believe a couple of different radiologists coming in to testify later today before you. They obviously can give you chapter and verse in much more detail. On exactly how it's affecting their practices. Much more so than I can.

REP. SRINIVASAN (31ST): Thank you Representative Becker, and your -- the comment that you made fortunately that when you went to DSS instead of raising the rates for the radiologists they dropped the rates for everybody else's. Everybody now is swimming in the same waters. So, and the reason they gave you that they were lowering the rate, was it just budget related? Is that the reason they said that they would lower the rates for the other provides and not increase the rates for the radiology services?

REP. BECKER (19TH): Representative that's my understanding, but I -- I would invite you to speak with DSS directly and hear their reasoning from them.

REP. SRINIVASAN (31ST): Thank you for sharing that, because that has been my experience too, because I have gone to them on behalf of other groups as well and once again, you know coming across the same situation that its budget related and that's why their hands are tied. And you know as you correctly said, singling out this one particular group and reducing their reimbursement rates will have --- has already had a significant impact as far as access is concerned, and so for public health to do that study and get back to us to see how well we take care of the Medicaid population and not under serve them is going to be critical as a committee. Thank you very much for bringing this in front of our committee today.

REP. BECKER (19TH): Thank you.

REP. RITTER (1ST): Any other questions? Representative Becker, always good to see you.

REP. BECKER (19TH): Thank you.

REP. RITTER (1ST): Okay, Robert Fiore and then I don't see Representative Staneski, but she would be next if anyone wants to text her. Oh, she just walked in, beautiful, you'll be next. Thanks.

ROBERT FIORE: Senator Gerratana, Representative Ritter and committee members, first I apologize for stepping out of the room but of course I'm living with epilepsy and I'm not supposed to miss any meals. More important than that, we appreciate the fact that you've interviewed three women, they're all here today and you see the severity of living with various forms of epilepsy. My name is Robert A. Fiore and I'm the President and Founder of the Connecticut Epilepsy Advocate recognized 501C3; a nonprofit organization that serves the entire State of Connecticut.

For the record I'm a resident of Milford and suffered with epilepsy my entire life. I'm here to speak in favor of House Bill No. 5450. The purpose of this bill is to make cannabis available to children living with epilepsy. For the record, we are aware that this bill also address other medical conditions however, today I'll be specifically addressing epilepsy.

We are convinced that children here in Connecticut living with Lennox-Gastaut Syndrome (LGS), Dravet Syndrome and very severe general epilepsy stand to gain tremendously from this legislation.

Here are a few examples of children who have been helped by using the correct cannabis oil. Louis was have 3000 seizures a month approximately a 100 a day and since taking cannabis oil has gone down to 1 or 2 a month. Charlotte went from 1200 seizures a month down to 2 or 3 a month. Haley went from 1250 seizures a month down to 734 continues to lower. Carolina went from 110 seizures in one month down to 20 to 25. Please understand that due to patient privacy concerns we cannot give their full name or place of residency.

For the record I've included a document entitled Doctors Statements or Support of Medical Cannabis for Epilepsy. That's from Lisa Smith who offers a wealth of information from numerous doctors.

We're also requesting that the tetrahydrocannabinol should be no more than 0.3 percent, that's 3/10 of 1 percent. We feel it's safer for people to start at a low level then increase if necessary. We would also like to suggest that the title of the legislation be changed to read, AN ACT CONCERNING THE PALLIATIVE USE OF CANNABIS OIL.

This way there is no confusion or negative connotations because yes, there is a difference.

In conclusion I strongly urge you to pass the bill which will help many Connecticut children suffering from various forms of epilepsy I've mentioned -- to pass bills like this should give you a clue as to the direct need for this legislation, which will have so many positive effects and according to our best science and no negative once. I thank you for your time in having me today and I'll gladly answer any questions whatsoever.

REP. RITTER (1ST): Thank you Robert and I know my co-chair and I enjoyed meeting with you a few weeks ago, and thank you for your testimony. I will say this, we don't make up the titles so there's not much we can do about that. That's done by non bipartisan staff but we will take your comments into consideration.

ROBERT FIORE: Thank you.

REP. RITTER (1ST): Any questions from the committee? Seeing none, thank you for being here today, we appreciate it.

ROBERT FIORE: Thank you.

REP. RITTER (1ST): Representative Staneski, followed by Marghie Guiliano and then Representative Kokoruda will be the next elected official. I know staff are texting their legislature so she'll be up.

REP. STANESKI (119TH): Sorry, I saw one of my constituent friends who had just testified and I needed to give him a hub. Now he's on his way to eat. Good afternoon Chairmen Ritter, ranking members Srinivasan and Senator Markley and distinguished members of the Public Health Committee, my name is Pam Staneski, I am the representative from the 119TH Milford and Orange. And I'm here to testify in support of S.B. 294, AN ACT CONCERNING SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITY.

One of the first things that I did as a new legislator was join the bipartisan IDD Caucus. I was drawn to the message of support for developmentally disabled and still am honored to advocate for those the caucus supports. It is with that passion that I sit before you supporting S.B. 294, as a start and in directing some of the concerns voiced by the community, residential waiting lists, and notification when state assisted care is deceased.

I was encouraged when I read a few weeks ago, that the governor's according to the Hartford Current, in an article on February 3rd said that they will develop strategy to address and fund the wait list. Here you as this committee have an opportunity to provide support in that endeavor by moving this legislation forward. These waiting lists cause major hindrances to those who want to live in their community, have their independence and secure job. It is incumbent on us to see that our agencies and providers deliver services when needed and that does not mean only upon the death of a caretaker.

The proposed legislation requires the commissioner to update the waiting list not less than once every three years. It does not specify which list, and there are a few. Residential, Day Service, Behavioral Services or Planning. It does on the require any reporting to this committee on the status of the north does it outline the information that will be updated.

I respectfully request that the language be included that will require the commissioner to integrate all lists into one, and provide the following data in a report to this committee, by redacted name, at the level of need and the support services requested and timeline of when they are needed, and the numbers of days and weeks and years on the waiting list.

I actually believe that this data is important for future planning around community infrastructure and supports and provides transparency of the process.

Notification to families that include details of services to be provided, modified or terminated, is paramount to long-term planning, and I think that's where we need to go, long-term planning. And I think the commit for recognizing the importance of this communication by requiring the commissioner to provide family's with transparent and consistent information to help them with the services.

I look forward to working with members of this committee, members of the IDD Caucus, and the community on anything we can do to advocate and provide those services.

I'll be happy to answer any questions. Thank you very much.

REP. RITTER (1ST): Thank you Representative for being here, and your testimony. Any questions?

Representative Srinivasan?

REP. SRINIVASAN (31ST): Thank you Mr. Chair. Thank you representative for being here and thank you for joining the bipartisan committee and the passion that you said you have to render help and care for these people. We appreciate that very much.

We heard extensively from the commissioner, I'm not sure whether being in the building you were able to hear her testimony or not. I know you must have been in other committees during the earlier part of the day. And a common, when we ask the commissioner about the waiting list, and the answer we got back which we are aware of, is given the budget restrictions and the money that the agency has, at the only people that they can take care of are the emergency list. And other than if you are an emergency, unfortunately they cannot take care of anyone because of the budget restrictions.

And so the comment was made that the number of people on the waiting list is about 2074 or 94 I forget, something in that ballpark. And telling a family that you are 1050 or 1059, according to the commissioner did not make much difference because in her words, false hope is what you would be giving this family because at 1000, did not mean anything, because unless you were an emergency nothing was going to be done any way.

So your question of creating this one list and creating this list of people numerically, and then saying they can be on that list for five years or ten years, do you think that will make any difference at all?

REP. STANESKI (119TH): Thank you very much for that question and those comments and I, I am sorry that I did not hear the commissioner's testimony before this committee. But when I'm out there and I'm talking with people in the community they are saying that this list is -- it's not really a list right now. It's a reach in and grab, and yes, I understand that we are, we have emergency situations and that's what we're dealing with first. It's unfortunate that we have gotten to the point where we have to 2000 members on this list. But I would say that as an educator, as a parent of four children, that any planning that is involved with my children's life and me in a partnership is better than nothing. So you may be 1000 on the list but you're on the list. And you know that there is a criteria that has been set by this body or by someone that allows you to see where you are. What's coming up and maybe planning. And these people are not asking for baby-sitters, so that is not the intent of let's get this done.

These people are asking for an opportunity to work in partnership with the agency on the care of their aging out children. And it's awful when you say to somebody if you have a child at 3 years old, and I was call yesterday morning, where I had a constituent whose child is in a wheelchair. She's very concerned, she's in elementary school. She said I am hearing about this list, I'm hearing about it -- and you're saying to her, put her on the list now because if you don't, there is more people that are going to be before you.

So I think that by generating this, and allowing for planning long-term planning, it's a step in the right direction and so, to the commissioner's comments, she may very well be right, it's false hope by saying your number 1000 on the list, but it's at least giving these families the opportunity to put something in place where they are having conversations about the need now, and the needs in the future. And planning, it could be through insurance, it could be through savings, it could be through programs that we offer.

So, I respectfully say that I think the list has a different meaning to the people who are on it.

REP. SRINIVASAN (31ST): Thank you representative. So you would say that you would like to have a list, excuse me, depending on the need base, obviously. And then keep changing that list as the need changes for that particular individual and have that reported to a body every so often?

REP. STANESKI (119TH): I would sir, and thank you very much for that. And what I'm saying is that, it's not a list that's stagnant. It's not a list that once it's made it's done. It's a list that's fluid and moves. And it again, it's offering that planning piece to the parents and to the families and to communities. And, we know that there are services out there besides just what the state would offer.

So if you start to plan with somebody when they are put on this list at age 6 or age 7, and they're starting to work through, then they have the resource of their community to reach out to, they have the resources from the state and maybe family -- I know that there's a program that the state is looking at, it's Passions in Community or Community in Passion Care. But we have a chance to make those work, so I, I just entertain that by offering them this saying we do want this list, and we report it back to you. It says there's good faith here, and we'll work with you.

REP. SRINIVASAN (31ST): Thank you very much. Thank you Mr. Chair.

REP. RITTER (1ST): Representative Sayers.

REP. SAYERS (60TH): Thank you Representative and I think you make some excellent points because as long as I've been up here I've been hearing about the list. And I know when I meet with families in my district, they know that it doesn't matter where they are on the list. What counts is when an emergency comes up, that's when placement actually happens. Not when your number comes up on the list, because at the emergencies are constantly pre-empting the list. And I think for us, to see what services are required. How many people are awaiting those services? And to see a comprehensive list would give us more than information going forward and we would be better able to address some of the issues and problems that have been around forever that don't seem to be going away, and don't seem to be changing.

Even as the commissioner indicated the list doesn't really change. So thank you so much for your testimony.

REP. RITTER (1ST): Thank you Representative Sayers. Anymore questions from the committee? Seeing none, thank you representative for being here today. We're going to do a slight -- Marghie Guiliano please come testify since you're here. And then we're going to have Lindsey Beck come by and testify after that.

I appreciate everyone in the room, indulgence to the committee. We have a long list, we continue to work through it and I appreciate everyone's patience in the audience, thanks.

MARGHIE GUILIANO: Good afternoon Representative Ritter, and members of the Public Health Committee. My name is Marghie Guiliano, I'm Pharmacist and Executive Vice President of the Connecticut Pharmacist Association. We also represent the Academy of Medical Marijuana Dispensaries, which is comprised of six, soon to be nine facility serving registered patients today.

And I'm here today in support of 5450, AN ACT CONCERNING THE PALLIATIVE USE OF MARIJUANA. It's been almost five years that we first spoke before the Judiciary Committee and I'd like to applaud the State of Connecticut, the Department of Consumer Protection for the program that we have in place. It hasn't been without it's growing pains, but if you look back over the past year and not even a year and a half, we have so many different dosage forms available and products are going t the required laboratory testing, so it's very exciting times for Connecticut for our producer dispensaries and our patients.

The CTA and its academy does support the recommended changes to the debilitating medical condition including those conditions that have been advised for children -- for patients under the age of 18, in a non-smokable form.

We also support the change in legislation to allow for research. We believe research is very important and I'm pleased to say that the Academy of Dispensaries has just had an institutional Review Board approval for research with a project with Yale University School of Medicine. So we're very excited about that project.

We certainly support the addition of Section 3B, that would subject a person with a valid registration, certificate found to be in possession of marijuana that did not originate from their selected dispensary to a hearing before the commissioner of Consumer Protection for possible enforcement action.

This really closes a loophole in the law that had previously allowed patients to purchase marijuana on the street. And this really helps maintain the integrity of our program. So we're very excited about those changes.

We only have one concern with Section 60, which adds the requirement for dispensaries to report data to the Department of Consumer Protection relating to the types, mixtures and dosages of palliative marijuana dispensed by each dispensary.

Currently, the dispensaries are required to submit data to the prescription monitoring program because this is consider a controlled substance. So we are just curious as to why we would need some additional reporting.

Thank you very much for your consideration and I will answer any questions if you have any.

REP. RITTER (1ST): Thank you. I would only imagine maybe the additional reporting is on the research aspect to allow them to understand what people are getting prescribed, the doses and what's working and what's not. But we'll follow up with the governor's office, on that.

REP. SAYERS (60TH): Think you.

REP. RITTER (1ST): Any questions? Seeing none, thanks for being here, we appreciate it.

REP. SAYERS (60TH): Thanks.

REP. RITTER (1ST): Okay Lindsey Beck and then Representative Kokoruda, who has arrived. And then it will be Timothy Yankee. And as a Red Sox fan I hope I got that right. And then Senator Kelly will be after that.

Hi Lindsey, how are you?

LINDSEY BECK: Good, how are you today?

REP. RITTER (1ST): Good, thanks for being here today.

LINDSEY BECK: Thank you for having me. Good afternoon ladies and gentlemen. My name is Lindsey Beck and I am a lifelong resident of Connecticut. I have now been here and fought on three separate occasions for my right to lead a qualitative and productive life. Because I still battle medically every day in small ways, I am held at a fixed income of $652 a month for my son and myself. If I were to purchase my medicine through a dispensary it would cost me upwards of $500 per month. I have in no way benefitted from the medical program I fought so hard and risked so much for. And I know patients across the state with the same problem.

I did not join this battle to ensure the wealthy their rights and deny my own. The bill was a disgrace and I always knew it, but it was a step towards a brighter future. You must amend Bill No. 5450 for home-grow, pediatrics and compassion program. Or patients will continue to suffer or be viewed as criminals.

You may wonder how I spend my days now, as the degenerate citizen you have forced me to become. I can tell you it is no longer days spent in bed, writhing in pain, passing out from the medication, wishing for the end. No, that is no longer the life that I chose to lead. Instead, I spend my days volunteering my knowledge to other patients in need. I connect them with resources that will help them pay these outrageous fees. I connect them with communities in other states who gift medicine to patients, always with real warnings that this is a illegal by Connecticut's regulations.

Do you not want to see your constituents thrive? I teach them safe extraction methods, so those who cannot benefit from any resources can still heal themselves and save their own life. I teach them proper dosing and how to comfortably build a tolerance. I do this because it must be done. And if you do not stand to do it, then I shall not remain seated.

When will you realize that in order to lead you must follow. You must follow your voters through their tribulations. Our pain must be your pain. Our struggle must be your struggle. Our needs must be your needs.

This is the job you signed up for. No one forced you to be in those chairs today. But because you do occupy them, you must listen with true intent. An intent focused on hearing what is being said, and an intent to act accordingly.

So hear me today, when I say thank you. Thank you for keeping me a criminal. Thank you for denying me affordable access to a medication I desperately need to thrive. Thank you for making my dreams of furthering my education impossible, as I cannot medicate on campus properties. Thank you for blocking my ambitions to work, as I am not eligible for immunity if I cannot afford my card. Thank you for keeping my son and me constantly afraid that DCF will be at our door. Thank you for locking the grace and decency to stand against the opposition and declare, I will not deny my constituents their health, their life, their right to liberty and the pursuit of happiness. Thank you for showing me that this system is further flawed than I could have ever imagined.

REP. RITTER (1ST): Thank you any questions from the committee? Seeing none, thank you for your testimony here today. Representative Kokoruda, followed by Timothy Yankee, and then Senator Kelly is next in the public speaking portion.

REP. KOKORUDA (101ST): Good afternoon Chairman Ritter, ranking member Dr. Srinivasan. I'm happy to be here today. I know you have a long day and I am going to be short. And I believe you have all been given the working groups document on smoke exposures to minors in vehicles, working group.

The legislation H.B. 5453, before you works to protect children from second hand smoke while riding in motor vehicles. It creates a ban on smoking in cars with children under the age of 18. I will tell you our committee worked long and hard, and we addressed three major areas. One was the ban, one was education or the lack of education in our state about the problems with tobacco, and funding. But this legislation before us today is strictly working with the ban.

Seven states have a ban today, including -- in addition Puerto Rico also does. The working committee recognized the health risks, and much has happened with bans in Connecticut. As you know we know ban smoking in restaurants. Most public places. Many towns and cities now are banning smoking from their parks even though it's outside, local parks. The results have been that there has been an overall decrease in smoking. So we're not only keeping people in these spaces safe, we've also had another major factor with a true decrease in smoking.

During the work of our committee, we recognized the enforcement related concerns, and we a realized also the difficulty with law enforcement to identify a violator in a moving vehicle. Therefore, this legislation, in a work group intended that this would be enforced as a second offense. It would be an infraction. It would be -- and I don't believe it's in the legislation but our intention was to have this be a warning for the first year. So I hope that's something you'll look at. And also this bill as written would not constitute a probable cause, if pulled over.

Finally, I just want to read from our working group. Our working group holds widespread acknowledgment that a ban represents responsible public policy in terms of the interest of children, and the protection of minors, who might otherwise lack recourse from their exposure to smoke while they're in a vehicle.

So I thank you for listening. I know we did this last year also. I know you have a lot of information and hopefully you'll look at the report. But I think this is a step in the right direction, and I think the time has come.

REP. RITTER (1ST): Representative it's always good to see you. And I'm sure Representative Genga has questions. I see him smiling over there, so here you go.

REP. GENGA (10TH): Smiling at your wisdom.

REP. RITTER (1ST): It's the first time I've ever heard that, so thank you.

REP. GENGA (10TH): Thank you Representative Kokoruda, and thank you for your advocacy and co-chair of this group. You know I agree with you. And yes, part of the recommendation was, and I'll read it right from the report -- citations will not be issued until one year after the ban becomes effective. Prior to this date police will only issue a warning. Would you address why that was?

REP. KOKORUDA (101ST): Well we, you know we certainly want to, the main goal of what we're trying to inform and to educate. And certainly being pulled over and being given a warning does educate you. I will say that we didn't want it to be punitive, we want it to be educational. We want this practice to stop, and we also have, it would be as I said an infraction. There's a small fee, but there is also different ways that you can have alternate remediation. You could opt out with taking a course on line. There's different ways that would be set up.

We don't want to be punitive, but if we're going to make a change in this behavior we need to at least have something that we can try to enforce to bring parents to the realization of making a mistake by smoking in cars.

REP. KOKORUDA (101ST): And last, would you --

Yes, we talked about funding and you know, -- we talked about funding quite a bit. This was all news to me. The State of Connecticut takes in almost a half billion dollars a year in tobacco products, taxes -- cigarette taxes and also our tobacco settlement fund. I believe it's about 180 million this year, from the tobacco settlement fund and the rest is taxes.

We are 38th in the nation with what we spend on trying to convince people not to smoke. Our education is dismal. We do very little -- this year, or next year if the proposal has been none. This year we're spending, well proposal was to spend 1.2 million. I don't know where that stands right now. Next year we're talking zero. We would be 50th in the nation with our commitment to do something about cigarette smoking. And half a billion dollars is pretty remarkable, 4300 kids a year tried tobacco for the first time, 4300. That is as they pointed in the graft, 89 school buses filled with children. And our educate -- we're battling the whole cigarette industry. Spending, I think it's 69 million dollars a year on marketing their products, and we are spending 1.2, very little, there's a lot of ways we can educate. We need to make a real effort.

I know it's a long time to do something with you know with the lack of funds right now, we know it's a problem. We know this ban will be a first step. We certainly hope we're back again to make Connecticut not number 38 or 50th but one of the top ones doing something about our children smoking and the health of our citizens, especially our children.

REP. GENGA (10TH): Thank you and for the Red Sox fan in here, I would just tell you I was -- I was explained to me by an advocate in the task force, if you took and filled Fenway Park, all those people they'd be gone tomorrow because tobacco is still the number one cause of death. Thank you.

REP. RITTER (1ST): And we appreciate it, I'll say two quick comments on this. We left out the appropriate side, obviously it's the appropriations committee and that was in the bill, the bill would have a tough time when it was GF'd to that committee.

The other thing, I see this per our staff, no person shall smoke in a motor vehicle as defined in Section 14-1 when a minor is present in such vehicle. It begs the question if I'm 17 and I'm smoking and driving, does it apply? And there is still a special question, which again I think we'll talk about as we go forward is, as a Harvard representative we're trying to lessen a bad interaction between law enforcement and our young men and women in the whole state but particularly in places like the City of Hartford.

And so it's really important to really make sure this language is very tight. I know the probable cause language is in there, but these are some of the same concerns last year which I'm sure we'll continue the conversation, so.

REP. KOKORUDA (101ST): And excuse me Mr. Chairman, may I just respond to that. We did have one member of our committee was from the Black-Latino Caucus we thought that was important. And you know what, when we started this conversation with the working group I think I was under the impression that we weren't going to really come up with a ban. As we were gathering their information and we talked a lot about the whole profiling issue last year and I understand that. It was pretty remarkable to watch this -- as the information unfolded about the lack of commitment of what Connecticut is doing for our children on this issue, and the health issues. Not only the cost but just the health of our children. It was remarkable to me on the final day that this was unanimous vote on our committee to -- under 18 ban and as the answer to your question I would assume if you're 17 and smoking in a car you're violating -- it would be violating this law.

REP. RITTER (1ST): It may need to be tightened up then, because the way I read it, I can argue both ways but anyway, I appreciate it. So of what your intent was.

REP. KOKORUDA (101ST): We'll count on you to do that.

REP. RITTER (1ST): Well, we'll count on each other, and any email -- I was talking to Representative Genga where things were missing an email would be wonderful with bullet points to send to staff because they're really working their tails off right now in the next few weeks, and that would be great. Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Mr. Chair, and thank you Representative Kokoruda and Representative Genga for your leadership and I had the opportunity and the good fortune to serve on the task force as well and I want to thank you all for all your hard work in getting us to where we are here today.

Just a question that I've always been grappling with. And I tried to raise this in our meetings as well, and I'm not been able to get a direct answer. I was wondering if you had any insight. The difference between smoking in a car as opposed to in -- we cannot legislate this and we cannot control this and let's say in an apartment, in a home where obviously the children are around you so on and so forth, and then obviously not to smoke is the ideal situation. We know the risks and we know the health hazards and so on and so forth, but there is only so much we can legislate and control. But have you any readings, come across is it the confined space that you're in the car for that limited period of time whatever it is, is that the difference between a car or any vehicle or a home setting?

REP. KOKORUDA (101ST): Thank you representative for that question. I think obviously when we first started to discuss this, we were tying it to a car seat. And as we as it evolved we were tying it to being restrained with a seatbelt. So I think that's why we were looking at such a confined space. I would think no matter how old the child other than an infant, if they were in a house or an apartment, they could walk to another space, walk to another room. The confinement issue was definitely tied to what we were trying to do, here and that's what we're addressing.

REP. SRINIVASAN (31ST): Thank you. Thank you for clearing that. Thank you Representative Kokoruda. Thank you Mr. Chair.

REP. RITTER (1ST): Thank you Representative.

REP. KOKORUDA (101ST): And may I just thank Representative Srinivasan for his support. We had a great committee but I have to say our true leader on this was Representative Genga, he was remarkable. I know you been working on this a long time. I am proud to have been involved with you, with this issue. And thank you very much, thank you.

REP. RITTER (1ST): Thanks everyone. Timothy Yankee, followed by Senator Kelly.

TIMOTHY YANKEE: -- it's less, bill allowing pediatric use. I am not a parent whose child warrants the use of a natural flower to help their condition. I just want to say that I believe in the decision being between a parent and a doctor. They are just trying to do what they need to do and that they what they believe is in the best interest of the child. I support this bill just not 100 percent.

My name is Timothy Yankee, and I suffer PTSD after a subdural hematoma on 2004. I originally became a patient in February of 2013, after seeing Dr. Philip Pikowsi. Months prior to my dispensary opening in July of 2014 I was arrested for the palliative use of cannabis. So far I've had 17 court dates for a plant that I believe I would have immunity for. I'm facing well over 50 years for less than an ounce of usable flowers and a couple of tablespoons of oil, well within our regulations. The police removed everything in July of 2014 and by the time I walked into the courtroom for the first time in October three months later I was destroyed. I had lost everything. My house and the start of my new career. I had now had DCF in my life all over a flower. A flower that I had not used prior to becoming a registered patient. Now the dispensary is opening the quality is unbelievable. The quality and the cost of flowers far surpasses any black market product that at least I know of. The problem is some patients can't afford either the dispensary or the black market.

In 2012 our legislatures, you, agreed to constitutionally you can't limit the immunity for a flower. Only the residence who have the financial ability to engage in the for profit business. If a patient doesn't violate the state regulations and is slowing acquiring medications to better their life, then please, within our state jurisdiction don't subject them to arrest and prosecution for having a plant. I'm in no way asking that you change anything that is written in our current regulations. I am asking you to consider removing the proposed limitations on the acquisition from only dispensary as listed in Section 21A-408DD of this bill.

Please don't allow lower income constituents immunity to become no more than a piece of plastic. We're discussing the flower from a plant. No one deserves to be in jail for flowers. Especially if those flowers effect that person's quality of life or their life in general.

I appreciate everyone for taking the time out of a short session to discuss issues such as pediatrics within this bill. And I hope to be able to speak with you on important issues in the future.

REP. RITTER (1ST): Thank you for your testimony. Any questions from the committee? Seeing none, thank you for being here today.

TIMOTHY YANKEE: Thank you.

REP. RITTER (1ST): Senator Kelly, are you here? Not seeing Senator -- to people in the audience, we cannot clap, we cannot jeer, we cannot cheer. So that will be the one time we request that, thank you. Senator Kelly is not here. Is Senator Boucher here? Okay, we'll go to Colin Sooney, please. And -- Representative (indiscernible) any one elected officials we'll keep an eye on you and otherwise we'll go to Commissioner Harris, thanks.

COLIN SOONEY: Thank you very much for hearing my support for Bill No. 5450 here in the State of Connecticut. I would also like to thank you or reviewing -- continuing to review change for registered patients in the medical marijuana program here in Connecticut. My name is Colin Sooney and I live in Gilford, Connecticut. I am diagnosed with PTSD and a registered patient. I've always treated with cannabis since I first tried it in 1985, I was only 10 years old and I knew then I was the first time that I had actually been comfortable. Comfortable with the people around me, comfortable with myself, comfortable in my own brain.

Getting relief was new to me and I definitely wanted more. I never turned to other drugs, and although I had considered it when cannabis became different to, to acquire, I never did. For me, cannabis was never a gateway drug. It was just a relief I needed.

I'd like to take a moment to point a few facts. National Epilepsy Foundation has publically and openly announced that not only has it been proven that cannabis oil can treat epilepsy, they support it's use in pediatrics to treat the condition and encourage more testing and research. Also, the National Cancer Institute openly states that cannabis has been shown to kill cancer cells in the laboratory and experts around the globe are beginning to agree.

While many adults do suffer from these conditions, children are often not afforded the joy of adulthood due to sickness or death related to epilepsy, cancer or other possible conditions cannabis may help to treat -- excuse me.

End of life treatment and the quality of life our loved ones experience during this time is very important. Patients should be offered any and all available options at the disposal of the prescribing physician and cannabis should be one of those available treatments absolutely.

Here in the State of Connecticut we have some of the most prestigious schools and students, in the nation including Yale and UConn. The medical industry is a very large industry boasting 3 trillion dollars of the nation's economy with the FDA stating that -- the FDA supports those in the medical research community who intend to research marijuana it is important that we support research studies and more work be done helping to better understand exactly what this plant offers.

Every year 15,500 children and 1 in 4 dogs will be diagnosed with cancer. Children and pets should not be excluded from the care and treatment with cannabis. Cancer survival rates have gone up greatly over the last, past years from 49 percent in the 1970s up to 68 percent today. I'm certain this can be directly linked to the growing acceptance of cannabis as a treatment. Still, quality of life at the end of life, must always be considered for the ones we love. Nobody wants to endure watching the ones we love suffer. It is irresponsible to continue to prevent the ones we love from access to the product they are comfortable with.

Here in Connecticut we as patients are unable to grow or process our own medicine. We are forced to purchase products from dispensaries we are registered at, and also we must chose from what the dispensary has available for products. Add this to the high pricing and lack of previewing of the medication and there begins to build an argument for home grow.

In this common opinion, excuse me -- it is common opinion of doctors such as surgeon general candidate and CNN Dr. Sanjay Gupta that unlike other drugs that may work well as single compounds synthesized in a lab, cannabis may offer it's most profound benefit as a whole plant if we let the entourage effect flower. With more and more information about cannabis becoming public knowledge it becomes more clear that --

REPRESENTATIVE RITTER (1ST): Mr.Sooney, could you please wrap up?

COLIN SOONEY: I'm sorry, thank you. Finally please one last note. As laws here, we're beginning to allow 11 year old children and above access to OxyContin from pain and possibly other conditions. I think it is absolutely irresponsible that we allow children to have a drug that is not been tested for dosing on young adults access to OxyContin and not access to cannabis.

Thank you very much for taking your time to listen to me right now. I did not get to finish everything I had but I do appreciate --

REP. RITTER (1ST): Thank you, well if you testify electronically we'll have it on the system, so.

COLIN SOONEY: Definitely I've already done that.

REP. RITTER (1ST): Thank you, any questions? Seeing none, thank you for being here today.

COLIN SOONEY: Thank you.

REP. RITTER (1ST): Thank you, I know it's an emotional issue but I would remind people we just got to -- even keel, we give our testimony and we, we'll go from there, okay? Senator Boucher has arrived. I see her and after Senator Boucher, we'll go to Tom Schultz, and then again Senator Bye, Representative Utile, Commissioner Harris in that order, depending on people appear so, Senator Boucher how are you today?

SENATOR BOUCHER (25TH): Today is an opposition to House Bill No. 5450, and I appreciate both the Chairs and ranking members attention to some of the remarks that I might make. As all of you know, and probably everyone in this General Assembly knows that I am strongly opposed to this bill. The focus of which is to extend the legal use of medical marijuana to children under the age of 18.

Most importantly, and probably the primary purpose of my opposition is that it exposes children whose bodies are still developing to a substance that has been linked to numerous health complications even in adults. Part of this legislation appears to anticipate these criticisms without drawing the proper conclusions from them. In fact, there is for sure many experts that note the lack of rigorous scientific study on the safety and effectiveness of marijuana as medicine. Now in fact to the point where we see that the Department of Consumer Protection is requiring some language in this bill to protect them from legal penalties, maybe anticipating some problems into the future.

The American Epilepsy Society have also asserted that more research into medical marijuana was needed and that the marijuana based treatments provided to children in Colorado has failed to meet FDA standards. In fact, just this afternoon I was reading about GW Pharmaceuticals which is the leading provider of products with cannabinoids have also expressed their concern about the components of that and it should be a certainly more regulated through the FDA process is what they do.

Even more worrying, the fixation on medical marijuana may have caused parents to look for this solution than better known and more thoroughly vetted treatments for epilepsy. One of the many scientific reports and I have one here from Colorado on the effects that they are experiencing medically from their program there, that I'm happy to certainly distribute or if necessary talk about it on the floor of at the senate should this bill come up. And I think that it's very important because we have to really repeat that prolonged marijuana use has been found to hinder brain development, resulting in lower IQ, poor memory later in life, and increased susceptibility of mental illness such as schizophrenia and psychosis. Marijuana use has been linked to heart problems in young adults to the suppression of the immune system and even to increased instance of stroke in young users.

Regular use may also lead to addiction and provide a gateway to more dangerous drugs. According to a recent statement by the Connecticut Association of Prevention Professionals, they state that people addicted to marijuana are more than three times likely to be addicted to heroin. A particularly frightening development in light of the heroin epidemic in Connecticut schools and emergency rooms that we're reading about unfortunately almost every day now. So we need to really tread, tread lightly.

You know some of the things that concern me the very most with young children is how a child develops in the womb, in fact that was something that I was very cognizant of having my three children in those first couple of months and how the brain was developing. Even now, there is an outcry that we have -- and we have legislation in front of you right now to talk about tobacco and its ill-effects as well on the very young developing brain. To increase the age for smoking to 21. In California they want it to be 25, and their principle reason is because the brain is still developing to the age of 25.

How could we then be entertaining this legislation when in fact we're doing the opposite with regard to tobacco. It seems to be a double standard in my view. And it's very, very important for us to really be careful about doing this. You know it was very interesting to me and you have my testimony but I was watching a program on television, Willie Nelson was being interviewed and Willie Nelson on TV said, you know all that I am pot user but don't ever administer it to young children. To anyone that's young because the brain will be permanently effected for life. Even Willie Nelson, expressed this concern.

So I believe this bill to limit tobacco in young children is a good step in the right direction for children and adolescents, whose brains are susceptible to it's effects and wish that the committee would adopt a similarly strident position in regard to marijuana and it's own health effects.

I really appreciate your time and attention. I could go on as you know for many more hours but I'll stop right here, and ask if there's any questions by the committee. And I thank you so very much for allowing me to testify today.

REP. RITTER (1ST): Thank you Senator Boucher, we appreciate you being here. I, I have two questions for you.

SENATOR BOUCHER (25TH): Certainly.

REP. RITTER (1ST): One is on the tobacco comparison. So none of the -- does it matter to you that none of this can be smoked by someone under the age of 18?

SENATOR BOUCHER (25TH): Well you know I did some research into that area.

REP. RITTER (1ST): Yes.

SENATOR BOUCHER (25TH): And really read a lot of information from the pharmaceuticals that have been involved in Stavics, which is a vaporized form of this and so on. And part of the issue that they are having, even with the oils and so on, is that the THC is the issue, and it's psychotic effects on the brain. And it's ability to be separated in order to dispense it. And apparently that the THC is a component to try to alleviate some of the issues that they're talking about, and that's the part that is very concerning to me. Because that's the part that effects the brain.

And certainly tobacco is a problem as well, and people equate alcohol, but again alcohol leaves the system in six to eight hours. Marijuana stays in your system up to 30 days. Our own legislators that work in the emergency rooms have actually told me that they can detect it in tests 30 days after smoking and it compounds as you smoke more during the month. This is why the addiction now, not only because of the ability for the body to contain it, but worse off, the THC of the 70s is now, could be up t 50 times stronger, and that's an addictive product. Just like we've made tobacco more addictive so that there's greater use, there's greater profit. Unfortunately people separate health components to the profit motivation.

REP. RITTER (1ST): Thank you. Last question on my end is, and maybe we'll agree on this one, so a child who is at the end of their lives, is looking at weeks or months to live. I have two kids, I can't even imagine or fathom that situation. Is here any disagreement they should be allowed to have medicinal marijuana, to ease their pain?

SENATOR BOUCHER (25TH): Mr. Chairman, from day one of this debate, I have said and offered to even co-sponsor a bill that if it was an adult or a child or anyone, if they were at end-of-life, they could be dispensed whatever medication would help them because you're not worrying about the long-term effects and permanently damaging the brain or creating a difficult problem for sure.

I must tell you, I received emails from a woman about my age who was dying of cancer and she was documenting her journey to death. And she went to a different state and at that hospital they gave her medical marijuana. And she wrote the most distressing, devastating account of the horrible experience she had at that moment. Because you never know how people are going to react to it.

So, you know you have to tread very carefully but yes, I agree with you because what it really does, and it doesn't take care of the underlying symptoms but sometimes it masks it. What it does is, it stones someone so they're not feeling it. And if you're in that bad a shape, you don't want to feel it whether it's morphine or medical marijuana, whatever it is. I'm on Board for terminal illness. It's just that if you have a chronic illness and you have prospects of living a longer life or developing or a child, God forbid, my concern is the children above all else.

REP. RITTER (1ST): Okay, I appreciate that answer. I'm glad we agree on that.

SENATOR BOUCHER (25TH): Thank you.

REP. RITTER (1ST): Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Mr. Chair. Thank you Senator Boucher for being here this afternoon. And obviously all of us in the building know how you feel on the subject matter, and thank you for not being here for hours as you said, you could be and I'm well aware of that as well.

A couple of questions I have, and you know how I feel on this as well, when it comes to medicine or a non medicinal, they're two different issues altogether. We're not talking about recreational marijuana here, we're talking about medicinal.

In medicinal marijuana, it is not just prescribed to a person and then there's no follow up, there's nothing that goes on, on an ongoing basis. Of course it's there. So this, in a way you mentioned that how is this person going to be monitored? It is prescribed by a physician or anybody who is capable of prescribing in our state, A. That person's responsibility is the monitoring of that particular individual. So, it is not willy-nilly, that this person is just prescribed and lost in the process.

And so though I do agree what you had said for end-of-life, it's a different situation. I agree with that. But taking it one notch or many notches lower into chronic situations which is not end-of-life, and I'm not sure if you will here earlier in the morning in the building, when you heard at the testimony of families that came here and that's how we started, this day today at 10:00 o'clock, where we are talking about intractable seizures. People who seize constantly, continuously and in that situation, not as a first line of treatment. These people have gone to multiple, multiple, multiple therapies and this becomes a choice, not the first choice but because everything else has failed and that's the purview of the prescribing physician, or the healthcare provider to make sure that it is not the first line of treatment, but the last line because everything else has failed.

And I'm sure you heard the Academy of Pediatrics, that testified on behalf of them. We had the testimony from them in support of the medical marijuana in the right situations and the proper oversight. Even then, are you concerned? And as you also know we are looking at investigational drugs being available for end-of-life. Because you know in those situations where conventional therapy is not able to take care of the situation and under proper oversight, do you still have concerns?

SENATOR BOUCHER (25TH): Yes, doctor I do. Because you're describing a perfect world. And in this area there is no such thing as a perfect world. The opportunity for abuse is great, and when you talk about the Academy of Pediatrician, you're talking about the Connecticut Academy of Pediatricians. The National, still is opposed to this. The National Association of Epilepsy is opposed to it. It just, if it were that easy to monitor, if it in fact that follow through did occur, and again we're not talking about end-of-life here because end-of-life, there should be very few if any rules with regard to it. The rules should be around others taking advantage of medication that is supposed to be for the terminally ill patient.

But when you're talking about young children, the issues you described was exactly what I was reading about this afternoon from GW Pharmaceutical Company, that talks specifically about that and the jury is out, it's unproven. And as I said, they are the leading pharmaceutical company that deals strictly in this kind of product, and it's other subsidy products along with. And they are very concerned about this, and are not supportive. They are supportive of good and better and more research on it, yes. But has not happened to date. And that is my concern when they say well give us the opportunity to do research.

Well, are we talking about Yale? Are we talking about Johns Hopkins University hospital or are we talking about a grower that happens to have a small lab outside of it's offices. We have to be very, very careful.

The University of Connecticut, their medical school yeah, let's give it to them. You know I'm all for that. But your, it's the cart before the horse. You want to -- don't do damage ahead of getting to the point where it can be done in a safe way, and if in fact, the components that can be extracted and used properly for that malady should be proven and should be tested and have results.

I'm just concerned that parents are grabbing at whatever they can because they have such a terrible situation to deal with, and I can really -- but there are medications far beyond what medical pot can provide with regard to those situations, as well. And that's what is being ignored.

REP. SRINIVASAN (31ST): Thank you Senator.

SENATOR BOUCHER (25TH): Thank you.

REP. SRINIVASAN (31ST): And I do share your concern about abuse, no question about that at all. Knowing what this can do and obviously having to deal with opioid abuse in our state as well. Do you think that, I know we don't live in a perfect world, I wish we did but obviously we don't. But in a prescribed setting where the marijuana is prescribed for the need of that particular child, in the proper dosages for the child, and obviously he's not given for an unlimited period of time, you know given for let's say a month at the time or whatever restrictions, you know the Board decides on. Even then, in that strict setting you are still concerned about abuse?

SENATOR BOUCHER (25TH): Yes, I am still concerned because it has not been shown that this is better than an alternative product for that child. That it actually -- is it actually doing what it needs to be done, rather than just medicating and sedating them completely. In other words stoning them to the fact that they can't be cognizant.

So there maybe an appeal to that, but I'd like to see this data that actually deals with and intercepts the epilepsy seizures that are actually going on in the brain. And it takes some amount of medical research. Again, I'd like to see where they have shown that pharmaceutically that, that is doing what it's intended to do.

REP. SRINIVASAN (31ST): Mr. Chair, with your kind indulgence can I ask one more question?

REP. RITTER (1ST): Of course.

REP. SRINIVASAN (31ST): Thank you Mr. Chair. Senator you mentioned about that on the medication, on medical marijuana that the individual is doped or looks in that -- you know, but we heard earlier today, was just the opposite. And what we heard consistently from those who came before you, well before you at 10:00 in the morning, and after that is, on these medications, prescriptions that are provided and what is available in our state at this point in time, those prescription medications, those tranquilizers, anti-epileptic medications, anti-seizure medications and the list goes on and on and on. That, that individual needs to control these intractable seizures, they had no life at all. They were doped, they were totally out of it. And when the switch happened because as I'm sure you heard, that people have left our state and gone to other states to take the medical treatment, and we heard the testimony earlier today, that individual is a different individual altogether, and just the opposite, exactly the opposite of what you are worried about and what you're concerned about is what we heard. I would like to hear your thoughts on that.

SENATOR BOUCHER (25TH): Well I will first apologize for not being here at 10:00, I actually am ranking member of two committees of Transportation Education and they are both holding public hearings as we speak today, all day. So I unfortunately wasn't able even to tune in. And I appreciate that. And being that you, I have such a deep medical experience and expertise I'm happy to share with you the leading pharmaceutical company's scientific discussion of just the issues that you're concerned about.

We did have when I was on judiciary at one time, I have a parent with a child there to testify and it just displayed very much some of the concerns that I had with the use of --

REP. SRINIVASAN (31ST): Thank you very much senator and thank you for all the energy that you bring into this building, we appreciate that.

SENATOR BOUCHER (25TH): Well, I hope that you all will be very cautious on moving forward on this and consider the well-being of the children first and foremost. And also understand how deeply this is effecting our Connecticut society when the perception of harm is reduced, the usage skyrockets when the perception of harm is less. I have a graph done by Dr. Douglas that will show that here in Connecticut the, when the perception of harm is reduced the usage goes way down. And there is a direct connection between our heroin addiction problems in the state and it's epidemic, and also the skyrocketing of use in marijuana in our high school children when you passed a bill that made it a misdemeanor -- a parking ticket for a half ounce or less.

REP. SRINIVASAN (31ST): Thank you Senator. Thank you Mr. Chair.

REP. RITTER (1ST): Thank you Representative. Thank you senator very much for your testimony. Good luck at the rest of your public hearings today. Tom Schultz, followed by, if Senator Kelly arrives he's up. Senator Bye, I don't see either of them, which would mean that -- oh, here she is great. Okay, so Senator Bye, unless Senator Kelly arrives, prior then he'd be up, thanks.

TOM SCHULTZ: Good afternoon member of the committee, members of the public. My name is Tom Schultz, I'm a New Britain native and a 20 year resident of Buchanan. For the last two years I've been President of the Connecticut Pharmaceutical Solutions Company. We're one of the four medical marijuana producers in Connecticut. And today I'm privileged to represent the Connecticut Medical Cannabis Council which comprises the four producers of medical marijuana in at the State. We're here to support H.B. 5450,and I've submitted my testimony. I believe it's been posted, so I'll deviate from that and try to get to the point.

We as producers working in the Connecticut system, are in the position of advisor. We produce medication that the dispensaries then give to the patients. We produce a final medication. In final form and consistent form, in replicable form. That's our obligations, that's what we do. Connecticut is one of the more pharmaceutical -- it's a leading pharmaceutical state, it's a leading medical state. Connecticut's program in my opinion, and in the opinion of many, is the leading pharmaceutical program in the country. Nothing else compares to this.

We have had in our own facility and a couple of other states through just trying to understand what we're doing and how we're doing it. We also have telephone calls from other politicians in other states trying to understand what it is that Connecticut has set up here. It's well known, it's very highly regarded.

The particular aspects of 5450 that we think enhance the program as it now stands are the research side and the availability of the product to minors. On research our current problem is that although we can send out product for testing for purity or for potency, we cannot sent it out to see how it might effect malignant cells in a Petri dish or in a test tube. We cannot send it out to see how it might do in animal models.

So for example if we have a situation that we're very well aware of, where a patient with Stage IV cancer has had clean MRIs and clean CAT scans we can't take the next, next logical step and see what is happening in an interaction between this medication and the laboratory. That's what 5450 would solve. So, we think that's very important with respect to minors and we think that the particularly with respect to life limiting and severe debilitating conditions, we'd follow the device we've seen in 2015 from the American Academy of Pediatrics and leave the decision making to the parents and the treating medical professionals.

REP. RITTER (1ST): Thank you very much. Any questions from the committee. Representative Carpino?

REP. CARPINO (32ND): Thank you Mr. Chairman, not a question but a comment. I just want to publically thank you. You were kind enough, I had a lot of questions, I just went through the process last year. Letting me go through the facility and I want to commend you and your staff for the knowledge you displayed the security. I was concerned with the facility being in my district, about the security surrounding the facility. It was top notch, and it was as clean as I hope every pharmaceutical facility is in producing medications and so I just wanted to thank you for sharing your professional knowledge here today. As well back home in the district as we were tackling some of this in months past, so thank you.

TOM SCHULTZ: Thank you Representative Carpino.

REP. RITTER (1ST): Thank you representative. The committee is good? Thank you very much for your testimony. Senator Kelly, I assume -- I don't see him so Senator Bye is up, if
Senator Kelly arrives he'd be up. Representative Utile is the next public speaking person or Commissioner Harris and then John Watkins is next for the public. Senator Bye it's always great to see you, how are you today?

SENATOR BYE (5TH): Great to see you Representative. Senator Gerantana, Representative Ritter, Senator Crisco, representative Riley, Senator Markley, representative Srinivasan and members of the committee. I think I got just about everyone.

My name is Beth Bye, and I represent the 5th District; that's West Hartford, Farmington, Burlington and Bloomfield. To give you a little context to my testimony today, to think the committee and support Senate Bill No. 294, I just want to say that what we have right now entering our developmental disabilities adult population, families who are used to having the protection of Public Law 94142 and having a lot of information and a lot of rights when it comes to how their children are cared for. Um, and then I now you've been hearing testimony about this today, but then they enter the adult system and suddenly things feel out of control. They're not sure how it works. They're not sure what their rights are. They're not sure how decisions are being made and this bill tries to fix that.

Right now, there are over 2000 people on the waiting list for the Department of Developmental Disabilities and it's been my honor to work with a very large caucus in this building, the Developmental Disability Caucus. We have over 60 members and we've been trying to pull together legislators about the challenges that people and families that have members with disabilities face. We've heard from thousands of families over the past few years, and this year and years past a profound concerns around the funding um, and budget cuts that these families face.

People with developmental disabilities are some of the most vulnerable citizens we have in the state. And I ask this committee to look at this bill before you and make sure that it lays out very clearly for families -- that DDS has to lay out very clearly for families what, how they make their decisions.

This bill requires notification of the state dollar amounts allocated for fundings, dates when change is made by DDS take effect, and requires clients to be informed of their options relating to DDS determinations.

It should also very clearly separate the varied needs of clients. And affirm their right to see the records that inform the decision of DDS. We need transparency for these families the kind that they get used to when their kids are going through the public school system.

Many families, even highly educated families who work very hard, are not clear on how the process works so I ask this committee to amend the language to make sure that the waiting list has language that defines the different types of waiting lists that there are.

Families have a fear that if they take certain services, say they take day services from DDS, then they get off the list for getting the residential services that they may be waiting for. I think this really could be improved a great deal. So families know the decisions they make. If they say okay, if I accept day services I go to the back of the line for priority for residential services.

So it's a really rough position that families are in and I appreciate this bill. I think the other issue is that the bill, make sure that the department provides documents that in whole or in part form the basis for their decisions that they make. And that those documents be provided in accordance with HIPAA and not use HIPAA as a blind to protect families from information to say, we can't do that. I think we can and must share as much as we can with families.

So I appreciate the opportunity here before you, to support this bill. And thank you so much for raising it, it means a lot to the families. And very briefly I want to weigh in on behalf of the family from West Hartford who has met with me a couple of times. They have a child with epilepsy with severe seizures and she showed me the amount of Valium that she gives her child right now during a seizure and I'd be hard pressed to think that that differs from medical -- the medical marijuana that, that child needs and in fact, that can help prevent the profound seizures that this child is having, requiring her to be knocked out.

And I'd also on behalf of my constituents in Bloomfield and West Hartford, ask this committee to look very carefully at all bills related to our water system as a working on a water plan and the citizens in Bloomfield are quiet riled up about taking of MDC water. So I couldn't help but mention that since I was before you but I'm happy to answer questions, thank you.

REP. RITTER (1ST): Thank you Senator, I know you're colleague from the Senate, my co-chair has a comment.

SENATOR BYE (5TH): Oh.

SENATOR GERRATANA (6TH): Thank you Mr. Chairman. Thank you Senator Bye, thank you for coming before our committee. And first I want to congratulate you, you've been an awesome advocate for people with developmental disabilities and for everyone, I should say. But earlier, the commissioner -- Commissioner Murray testified and she was very thorough, I would encourage you to look at her testimony page after pay if you recall her testimony in Appropriations it was very comprehensive, and she does show, she even attached and she does show the intake information in the forms that people fill out. And she also mentioned that she would be very happy and willing to work with coming up with a process that would not let anyone if you will, fall through the cracks or you know get lost in the shuffle -- whatever cliché you want to use there. Her testimony was very, very helpful and she seemed very encouraging.

So, I would look forward to working with you and with her on something that you know we can come up with. She testified for a good half hour if not more. And we asked her a lot of questions. So she was -- I thought she was extremely helpful in giving some suggestions. I think there is some hope there, maybe we can work something out. And I appreciate too your testimony, you're information about medical marijuana and of course the water plan. You know we have a number of pieces of legislation, you know that address water plan issues, so I thank you for that too. And thanks for coming.

SENATOR BYE (5TH): Thank you Senator and my office is in agreement with you, that the commissioner had very thorough testimony and we will look through it and make recommendations. I think we're all on the same page, we all want what's best for citizens of the state. I just think it's hard for us maybe some people here have children or people with disabilities in their life, but these families have so much on their plate that anything we can do to help them understand the system and be more transparent I think is the least we can do for the families.

So but I really appreciate your support.

REP. RITTER (1ST): Thank you, I think Representative Srinivasan has a question and that'll be it, thanks.

REP. SRINIVASAN (31ST): Thank you Mr. Chair, thanks Senator Bye for being here and for all the advocacy that you do on behalf of these people. As Chairman Gerratana just mentioned, you know the commissioner gave us a detailed report, very detailed which, as you said, your office has is going to go into and come back with recommendations. And the impression that I got or the take home message after her testimony is similar to what you just now said, the communication gap is what I see is happening. And according to the commissioner, the commissioner's office all that we're asking and requesting in the bill, a good part of it obviously not all -- a good part of it is already done or -- but that's not the message I get. I too like you in Glastonbury where I meet my constituents; I hear the same thing that you hear on a constant, consistent basis that how come we got taken off the list? How come I don't know where I am on the list? Are the same things that you have heard as well? And I think it's a question of what is there. You know how do we communicate that best to the people and make it easy for them to understand what they need. I think that's what the, that we all need to deal with and hoping that we'll be able to do that.

SENATOR BYE (5TH): Thank you representative, and I, I agree with you and I think that's why the legislature plays such an important role outside of the administration because we do hear from constituents about what's really happening on the ground and raising bills like this allows us to have this conversation with the administration and support our families that are saying maybe the statute said this and maybe the procedures say this but on the grounds we have concerns, so I appreciate your advocacy on these issued as well.

REP. SRINIVASAN (31ST): And I want to also thank you for bringing the anecdote that happening in your town about the use of medications to control the intractable seizures, and how the use of medical marijuana in that particular situation if approved would probably change the quality-of-life A, for the individual and for the family as well. And that we can assure you we'll be looking very closely in this committee. Thank you for your advocacy.

REP. RITTER (1ST): Thanks everyone. I think we're good. Senator Bye, great to see you, thank you. John Watkins, followed by Representative Utile who has arrived. And then after Representative Utile, it will be Cara Tarricone, and then just reminding folks we're doing the best we can and thanks for being patient. Just make sure that microphone is on, sir.

JOHN WATKINS: Oh, thank you. Good afternoon my name is John Watkins. Thank you for your time this afternoon. I'm here in support of House Bill No. 5450, now initially I honestly was going to come here and sit down and give you guys a bunch of statistics and facts and let you know all the neurologists that I've spoken to from NYU, Denver Colorado, from California but I'm not going to bore you with this stuff. I'm just going to sit here as a parent. My daughter was born with a condition called cortical dysplasia, and I don't know if anybody is familiar with that but what it is, is it's a brain abnormality and where, if someone experiences brain damage the brain has plasticity and has the ability to heal itself. With an abnormality the brain just sees this as normal, and just expands on the abnormality. This has led my daughter to having upwards of 80 seizures a day. And I don't know if anybody can relate with what it's like to sit there and hold your baby while it convulses and you have no power over it and to sit and feel helpless at something like that.

I'm here in support of this bill, because I've done the research, I've talked to the neurologists, I've done the tours around the country but I'm not going to bore you with that. I'm a parent and I'm here to plead with the State of Connecticut to give my daughter a chance at having a normal life. My daughter's seizures were so extreme that we had to do corrective surgery which lead to the resection of the occipital temporal and perineal lobes of her brain.

Today my daughter is for the most part seizure free and thank God for that. So she for the most part probably won't even qualify for this program. However, I do know of lots of parents that have not taken this course of action, that have seriously sick kids, and I just want to level with you guys, you know seriously words like medicine and politics shouldn't even be in the same sentence together. These are conversations that should be shared between the doctor, the parents and the patient, not our state leaders. This is private communication between the healthcare providers and the patients. We shouldn't even really be having this conversation. This is just something that I should be able to talk to my daughter's neurologist about and move forward with preserving my daughter's quality-of-life.

So I'm here as a desperate parent that you guys just push this bill through so not only can these kids have the potential of living a better life, I'm not going to say they're going to live a normal life. But a better life, and there can at least be a piece of mind for the parents. Whether it works or not, in the end they're going to know. And if it helps then, let's -- let's help. Let's help, please.

REP. RITTER (1ST): Thank you Mr. Watkins. Thank you for your personal story.

JOHN WATKINS: Thank you for your time.

REP. RITTER (1ST): Any questions from the committee? Again, we appreciate your personal story and for you being here today, and for your patience. Representative Jutila, who I know is bringing a few people up with them. I just ask that they identify themselves and if they've previously signed up on another list, just kind of let the clerk know on your way out. After Representative Jutila, we have Tara Terricone and then Commissioner Harris and Deputy Commissioner Seagull.

REP. JUTILA (37TH): Good afternoon Senator Gerratana, Representative Ritter, ranking members Markley and Srinivasan, vice chairs, members of the committee. We appreciate the opportunity to testify today on House Bill No. 5460, AN ACT CONCERNING THE ADMINISTRATION OF GLUCAGON IN SCHOOLS. I have here with me Ella Stone, who is the driving force behind this bill who brought it to my attention, and has a story to tell you today, and advocacy on behalf of the proposed bill. And we also have with us Ella who has brought along a couple of experts to provide some additional fire power. We have two doctors here, Dr. Susan Ratzon and Dr. Julie Petersen -- oh, sorry. Okay, okay and I'll let them introduce themselves when they speak as well, but I just wanted you to know who we have here.

So I know the committee is very busy you've had a lot of speakers, I've been watching some of it and you have more ahead of you so I'd like to turn it over to Ella to tell her story.

ELLA STONE: Distinguished chairman and members of Public Health Committee, for the record my name is Ella Stone and I'm here to testify on H.B. No. 5460 AN ACT CONCERNING THE ADMINISTRATION OF GLUCAGON IN SCHOOLS. Before I begin I'd like to thank you for giving me this opportunity to speak out on the topic. This is a very important issue to me and my family. Today I have with me my parents, step parents, aunts, grandmother, a teacher, a state trooper, two doctors -- a doctor and a diabetes educator and eight of my closest friends. I also have about 82 other students watching at home, I am so incredibly grateful for all the support I've received on this bill.

Every day diabetics are reminded of the burden they carry by at least five shots, five finger pricks and for most children their school nurse. These not-so-gentle reminders will not stop for the rest of their life. I received one too many reminders on November 11th 2015 when I was told I could not attend a school field trip with my friends. This mishap brought me to contact Representative Jutila in an attempt to improve the experience of the children with diabetes in our state.

With all due respect I do not feel it is necessary that the Connecticut State Law 10-312, is yet another reminder to diabetic students and their families of this difficult disease.

There are family who cannot make it to every school trip and who are removing glucagon from the child's required medication list. Law 10-312, is cornering them into putting their child's health at risk, all because this law is discriminatory. There are also children being told that they cannot attend field trips because no one is trained and their parents are unavailable.

Not only is this illegal, but heartbreaking to young children and frustrating to parents. But the most unrealistic part of the way this law is written is that other licensing measures including CPR, AED use, and EpiPen for anaphylaxis are all considered mandatory. It is unfair that glucagon is the only licensing measure considered voluntary.

After explaining this bill to many people over the past few months. I've run into common misconceptions among the general public. Probably the most recurring concerns the school liability. Fortunately, school personnel are protected under the (indiscernible) meaning that if there was an error in the administration of glucagon, neither the school or staff member would be held responsible.

In a perfect world, every school would have additional nursing staff to handle this gap in care. As you probably know, school budgets are enough pressure. The answer is simple, appoint an appropriate number of people to administer lifesaving glucagon in an emergency just like EpiPen for allergies.

Regarding the actual training, it is very simple. In fact my father, stepmother, grandmother, aunts and even my 15 year old step brother have been trained. None of these people have medical backgrounds or certifications.

I am asking for three things, access to care if needed to be included in the same experiences as my peers, and the opportunity to not die. As a Type 1 diabetic I support House Bill No. 5460. I remember feeling that diabetic children's live were considered inferior to children with other needs. It was honestly the first time I had ever personally felt discrimination.

My greatest hope is that no other child in our state will ever ask the question, is my life valued less than the child sitting next to me? Thank you.

REP. JUTILA (37TH): One thing that I forgot to mention when I introduced Ella, is that Ella is an 8th grader at the East Lyme Middle School that may surprise you given how well put together her testimony is and what an excellent story that she has to tell. So if I may, I can -- can I turn it over to the experts?

REP. RITTER (1ST): Absolutely, and I would say I have an eight months old daughter and if she's as mature and as poised as you are when she 's in eight grade, I'll be a very proud father. So thank you for your testimony. So, and the experts if you want to weigh in, please.

SUSAN RATZON: Senator Gerratana, Representative Ritter, and members of the Public Health Committee, thank you for allowing me this opportunity to speak on behalf of the Bill No. 5460, regarding the use of glucagon in schools. I am Susan Ratzon and I'm a member of the Division of Pediatric Endocrinology at Connecticut Childrens Medical Center, former Division Head and Professor of Pediatrics at the University of Connecticut School of Medicine.

Over my 40 year career as a pediatric endocrinologist in Connecticut I have cared for literally thousands of children and adolescents with Type 1 diabetes who require lifesaving treatment with insulin, which must be given either by multiple daily injections or through a continuous infusion of insulin by a pump connected to a catheter placed into the subcutaneous tissue. This sometimes is a little surprising when you see how healthy, treated children with Type 1 diabetes are, like Ella. Despite the child's or parents or the caregiver's attention to monitoring blood sugar levels many times a day with a goal to keep the blood sugar at levels as close to normal as possible.

The current treatment available is imperfect in matching the healthy pancreases tight control of the blood sugar and the narrow range of normal, which is necessary to avoid long-term complications of this lifelong disease. As a consequence of treatment, our patients are at risk for developing severe low blood sugar levels, which is called hypoglycemia, which may result in mild symptoms such as lethargy or shakiness, to severe symptoms such as seizures and coma. These symptoms may develop suddenly without warning and in an otherwise healthy child who is doing well and managing their diabetes.

When recognized, mild symptoms can easily be treated with a fast acting carbohydrate taken by mouth such as juice or sugar tablets. However in the case of severe symptoms of hypoglycemia, the child or teen maybe unable to cooperate due to having a seizure, an altered combative personality related to their low blood sugar, vomiting or lack of responsiveness completely.

These are the symptoms of the brain being starved of it's source of energy or glucose which can be as life threatening as the brain being starved of oxygen. Prompt treatment is critically important. In these situations all of our families and caregivers are taught to administer the hormone glucagon by either subcutaneous or intramuscular injection. Glucagon works to raise the blood sugar by releasing sugar r glucose, stored in the form of starch from the liver. It works in a matter of minutes. It's safe, and I always tell parents who would call in the middle of the night with a child having a severe hypoglycemic episode, you can't hurt someone by giving glucagon, no matter where you give it, and almost how you give it. So it is safe.

We teach our families to do this immediately and to call us after they've given it -- you know we want them to give it quickly so that we don't want them to delay and then call for medical help if needed.

Since children spend approximately 190 days a year in school it's imperative that emergency treatment with glucagon be available to treat severe hypoglycemia whenever the child is in school or at a school sponsored function.

This certainly can be done and is done by the school nurse. But a non medical trained person may be able to do this just as competently and safely. Just as epinephrine is administered by a non medical trained personnel.

So I support this bill that is proposed today to remove -- which is really just a slight, but important modification of the previous bill to remove the word volunteer or voluntary. So the way it stands now, the school is supposed to identify someone who volunteers to administer glucagon in the absence of a trained medical person such as the school nurse. When that person isn't available, or hasn't been identified then nothing is done.

So, I think this is probably everything I needed to say. Thank you very much for allowing me to testify.

REP. RITTER (1ST): Thank you. Did you want to go as well? Okay, thanks.

JULIE PETERSEN: May I speak from here?

REP. RITTER (1ST): Sure.

JULIE PETERSEN: Okay, thank you. My name is Julie Petersen, I'm a certified diabetes educator also from the Division of Endocrinology of Connecticut Children's Medical Center. I've worked with children and their families with Type 1 Diabetes for about 11 years. I'm also an advocate and educator providing support and education throughout our state to local public and private schools, day cares, camps, group homes and other hospitals to ensure everyone who takes care of children with diabetes are well equipped to manage the day in and day out tasks associated with Type 1 Diabetes. I'm submitting this testimony in support of this bill.

As an individual loses the ability to make their own insulin like those with Type 1 Diabetes, so does the body lose the ability to make the counter regulatory hormone glucagon. This hormone raises the level of glucose in the blood. Glucagon and insulin are made constantly by our body in our pancreas throughout the day to keep our blood sugars in perfect balance. Those living with diabetes are constantly needing to think like a pancreas. And yet, despite the best education tools technology and medications currently available dangerously low and high blood sugars can still occur. Emergency intervention needs to occur immediately without delay to prevent further complications or even death.

Most children with diabetes are self-managing. Many of the daily tasks of living with diabetes, like checking their blood sugar, treating mild low blood sugars, taking insulin via injections or pumps. Treating high blood sugars and balancing the impact of foot, physical activities and stress on a daily basis.

But an individual cannot intervene on their own when experiencing a severe low blood sugar. Everyone who uses insulin should have access to glucagon emergency kits, at all times to treat -- to be treated for the severe low blood sugar.

We are fortunate in the state of Connecticut to have school nurses available in most schools, most of the time. And we all appreciate that. But children with diabetes have the right to access all school related activities, functions, programs, field trips, everything involved in their academic success. In 2012 I was part of the Connecticut legislation that was passed allowing this bill to first be implemented. And what a great first step that was.

However, despite this bill many children with diabetes have continued to not receive and fair access -- because of the voluntary nature of this bill. I deal with schools on daily basis, and this is a constant struggle and we're so thankful that Ella has brought this to the attention again. I think everyone here can agree that glucagon treatment requires the operators to be composed, confident and competent in the whole procedure. All of these things are attainable through proper education and re-education. Bill No. 5460 is not denying that. Connecticut needs to now take a next step forward. We're a progressive state and we need to show that and make glucagon for non-medical staff mandatory as it already has for other lifesaving measures like EpiPen, CPR and AED. Thank you for your time.

REP. RITTER (1ST): Thank you very much. Representative Jutila do you want to say anything in closing or?

REP. JUTILA (37TH): I would, thank you Mr. Chairman. I would just like to sum up basically in one sentence that you know quite simply all we're looking for here is to put glucagon on the same level as epinephrine, which are all part of the same statute in different subdivisions and take out the voluntary part so we would be assured that someone in the school if the school nurse isn't available would be trained to administrator glucagon. It's really just that simple and as Ella pointed out, the training is minimal. Many members of her family have been trained and it doesn't take a long time, and there ought to be somebody available to administrator this.

So thank you for giving us the opportunity to testify and to do that together. I think it's better that you kind of heard the whole story together from someone impacted by it, and from the experts as well. So, thanks again.

REP. RITTER (1ST): Did you miss school today Ella, by any chance? Did I get you out of a test?

ELLA STONE: No.

REP. RITTER (1ST): No? Sorry about that. You should have scheduled a day that you had a math test or something, so. Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Mr. Chair. Thank you Representative Jutila and to all of you for coming out here and testifying today. Just two questions, the mode of administration of glucagon is it subcutaneous? How is it administered?

SUSAN RATZON: It can be given subcutaneously. You can actually use a very tiny insulin needle. It can be given intramuscularly. There's a slight difference in the rate of absorption. But we actually also use it for other problems, intravenously. So you really can't make a mistake. If it goes into a blood vessel that's no problem. It does what it needs to do.

REP. SRINIVASAN (31ST): Thank you. The options that the person has, but in this situation that we're dealing with in school --

SUSAN RATZON: Yes, subcu yes, subcu would probably be the easiest. And actually Julie has a kit --

JULIE PETERSEN: And not to take up more time but I do have a glucagon demonstration kit and it shows what the medication comes -- how it comes. So it comes in this kit, and inside of the kit there are two components. There is the syringe which is filled with a diluent and then there is a vile, which we fill with the powder tablet. And the person would have to learn how to reconstitute this. But it is three steps. You insert all of the liquid into the vial. This is all safe so nothing is happening, sorry. You then swirl this around. It can take between 5-15 seconds for most of the powder tablets to be dissolved into the liquid. You then flip it over and you draw out the amount and on the syringe there's two doses. There's either half the dose, which is 0.5 milligrams or 1 milligram. You would draw that out and I know there is always a margin of error and this is the big -- this is the big hindrance or fear of a lot of people but you can't really do this wrong. If you, if you left out a few, a little bit of the liquid, you're not going to, the person is still getting a lifesaving dose.

And then you take it out and you can put this needle directly through clothes. And we advise people to do it right into the front of the thigh and get it. And the person would want to be laying -- safely laying on their side.

And we just feel very strongly that with education and training, anybody can be and should be doing this. And of course 911 would be called at the same time so that appropriately so that there would be medical management, you know a medical professional to take over too.

REP. SRINIVASAN (31ST): Thank you for the clarification and the demonstration, that was very useful. So it is kind of an EpiPen the two doses. The only difference being with EpiPen you don't have to reconstitute and here you have to. That's the only difference.

JULIE PETERSEN: Yes.

REP. SRINIVASAN (31ST): And it can be given subcutaneously as I -- because I want to make sure about that.

JULIE PETERSEN: Yes.

REP. SRINIVASAN (31ST): So are you, are you suggesting that the voluntary part be removed and every school have a mandated person obviously in, on the schedule that somebody should be in --

JULIE PETERSEN: In addition to the -- in addition to the school nurse, we're proposing that if the school nurse is not going to be available at every function, which is very reasonable that's impossible. Then there need to be other personnel in the school mandated to give glucagon for this lifesaving --

REP. SRINIVASAN (31ST): Yes, thank you very much. Thank you Mr. Chair.

REP. RITTER (1ST): Thank you Representative, and committee. It looks like we're good. Thank you all very much. Representative Jutila, always great to see you. You are well represented. You too, Ed. And now the school can be fully staffed again, as you guys all go back. Thanks for being here today and for your patience, so. Okay, Cara Tarricone, followed by Commissioner Harris, and Deputy Commissioner Seagull, they come together. Is Cara here? No Cara. Uh, I'm having a tough time reading this, it looks like a Stan Gold or Steve Gold? Stan, S.G. initials on 5450? Okay, so if they come back late if not after a long wait, Commissioner Harris and Deputy Commissioner Seagull, Jeanette Walden from Chief, will be next after that.

COMMISSIONER HARRIS: Thank you Mr. Chairman, as always in front of this committee that I have the privilege of chairing it's worth the wait and I want to thank you, and co-chair Senator Gerratana and the ranking members Representative Srinivasan, for allowing the department and giving us time today to testify in favor of House Bill No. 5450. I also want to give some thanks very quickly to the legislators that came out and toured the producers and the dispensaries, extremely important Representative Carpino is one of those I'd like to thank that said that she was there. I do know that for a fact, because it's key to learn about this program so we can really separate fact from fiction. And all of us while we can disagree, at least make it off the same plate of information.

I'm going to turn it over to Deputy Seagull, because she's really the expert on this. Michelle was deputy in 2012 and helped craft the initial legislation. She was the key author of the regulations, worked on this bill last year and of course this year too. And along with Commissioner Rubinstein and our professionals in drug control, John Guday and Xavier Soto have made this program not real on paper but real helping people every single minute of the day, to get relief from symptoms, from pain, and even underlying disease condition. Research and anecdotal information showing.

I'm just going to quickly set the context because this is a program that has you know under your guise with what you've done, the statute and in
Reg, matured quickly. So in May of 2014, there were 1325 patients that were registered that have their card. There were at that same time 83 positions. A year ago when we testified, when Michelle testified on the previous iteration of this bill, there were 3027 patients and 187 positions. This morning the snapshot was we have 8671 patients and 435 positions. Just the position increase alone shows that the stigma is being broken down. That there's more growing acceptance from the medical community. I want to have special thanks, here have been a lot that have -- from the medical community that have given us advice but in particular to the pediatricians. We had discussions with them last year and this year. And I will tell you, because of their input and their guidance, this is a better bill than it was last year, and I want to thank them for that.

And with that, I will turn it over to Deputy Seagull to give you the specifics and answer questions.

DEPUTY COMMISSIONER SEEGALL: Hi, and thank you all for having us here and you have uh, our written testimony which really outlines a lot of what's in the bill. So I'll give a really high level overview and then I'm happy to answer any questions. Basically trying to accomplish to three things with the changes we propose in this bill. One is to enable research in Connecticut and we really have as you have heard from some of the other testimony a framework here that's very medical, very pharmaceutical. So the groundwork to do real serious research is here in Connecticut and to leave -- are proposing some legislative changes that would facilitate that.

The second thing we want to do is address some compassionate need issues. Um, certainly you've heard from a lot of the parents and patients who are under the age of 18 so that's a big piece of that. We also propose some changes to facilitate getting medication to patients who are in hospice facilities or other sort of end-of-life situations. And then there is some changes mostly meant to streamline and enable us to administrator the program a little bit more easily from issues dealing with how we license laboratories and things along those lines.

But big picture, that's what we're trying to accomplish with these changes, and with that I'm happy to answer any questions.

SENATOR GERRATANA (6TH): And thank you very much for our testimony. Representative Candelora has a question.

REP. CANDELORA (86TH): Thank you Madam Chair. Thank you for your testimony. And I don't know if you were here earlier but there was some discussion over the panel of eight doctors, and how we're looking to add a pediatrician. One of the comments that was made is that it is a recommending body, so they'll look at you know the different illnesses that they might deem worthy of being treated. But there isn't a mechanism to necessarily remove illnesses -- especially if we're beginning the research component and we might find down the road that you know glaucoma for instance isn't something that should be treated and maybe it could be even harmful. But there's no mechanism to remove. Is that your interpretation of the current law? And if it is, should we look at that issue?

DEPUTY COMMISSIONER SEEGALL: So two things one, we cannot as DCP remove a condition but of course all the conditions were put in legislatively so you could certainly pass a law removing a condition so that avenue would exist in that way. Second, with regard to whether you should I'll certainly leave on that, that's somewhat of a policy decision. Certainly with other medication there are limited lists of conditions that fully limit doctors and how they would prescribe medication. So it would be whether you believe doctors need to be having more or less with regard to this type of medication. But I would leave that to you. But certainly you could pass a law.

REP. CANDELORA (86TH): Okay, thank you. And then looking at the panel of A, there's always discussion and concern about the addictive side of marijuana and the negative effects. Does it make sense to even look at putting somebody on the panel that sees the back end of patients potentially? So somebody that that has knowledge in addiction treatment?

DEPUTY COMMISSIONER SEEGALL: It would certainly be a good idea and if there was a doctor with those types of qualifications. One of the changes we've included in this proposal would be to broaden the range of specialties for physicians who could be appointed to the board. So, certainly a doctor who was interested in being on the board would certainly, it would make sense to consider that person.

REP. CANDELORA (86TH): Thank you and then last week having participated in the regulations review process in the decision making of expanding, there was discussion to what extent, what authority the commissioner has over blessing the recommendation or rejecting the recommendation so that the illnesses may not be expanded. He would take the recommendation from the board, and that doesn't necessarily, because they made a positive recommendation for say, glaucoma, that doesn't necessarily end up on the expansion list. The commissioner has the discretion to put it on or not. Should we you know if, if we're looking this board and we're looking at them being the experts, should we change that process? Would you think the commissioner should have that discretion, or should we have it you know as a situation where I guess if the panel rejects an illness, that issue then would be foreclosed. The commissioner couldn't reverse it and make a recommendation to Regs Review to say, add that illness to the list. Do you think that, that would make sense that these expert's decisions would be final if it was a negative recommendation?

DEPUTY COMMISSIONER SEEGALL: I think as good practice I expect commissioners would always follow the recommendations of the Board of Physicians, so you know right now the law is written that they make recommendations, would be open to discussing it. If you think that needs to be tightened. But I would be hard pressed to imagine a commissioner wouldn't rely on that medical expertise, and we do have some terrific physicians I will say, on our board and the way it, the seriousness and the effort they put into that. I expect that continues -- I don't see that would become a major problem either way.

REP. CANDELORA (86TH): I just, I know that issue came up in Regs Review and it ended up no causing us to remove one of the medical conditions and I'm just thinking going forward maybe we do want to clarify that so the Regs Review Committee doesn't get into that situation of having to debate the underlying recommendation. That if it goes before the committee we know that it got an affirmative vote with you, I thought.

DEPUTY COMMISSIONER SEEGALL: Right, I mean the one that Reg Review to clarify for those who may have missed it, it was tie vote with two physicians favoring and two opposing adding it to the list of conditions. On the Board of Physicians the commissioner is himself a member of the board who may vote and so, although he didn't technically vote at that meeting, in his authority to propose regulations he was in agreement having heard the evidence and understood the consideration that all the doctors took with the two who did propose adding the condition. So that sort of, -- I was not a situation where the physician overwhelmingly disapproved of that and we overruled that recommendation.

REP. CANDELORA (86TH): Right, and I appreciate that background information. Because I do think we might need to clarify it because I don't know where I read whether I was in Reg or in the statute that the commissioners s an ex-officio member so I think we probably would need to clarify if the commissioner is actually a voting member or if it is just us eight individuals because I think that it's just vague right now.

DEPUTY COMMISSIONER SEEGALL: Okay, yeah so it's in the law. It's where he's designated as an ex-oficio member which as I understand means he's a member by virtue of his title but our understanding is that he could be a voting, or she could be a voting member. That certainly needs to be clarified. I will defer to you on that.

REP. CANDELORA (86TH): Okay, thank you. And then one last broader question in terms of the expansion of this for children. Right now I think as it's written we're lumping adolescents with adults in terms of access. I know there's a different pathway for access where the child needs to have recommendation from the pediatrician. Should we be bifurcating this so that when we're looking at what illness are going to be treated, you know there's a category of illnesses that an adult would be treated with and then there's a category of illnesses for a child, as opposed to I think as I read this as it's written, all the illnesses are combined. So if we're expanding the list or you know we have items such as glaucoma or things that are traditionally more of an adult type illness that we shouldn't be sort of putting children in that category. We should be making it clear which illnesses are for treating children and which illnesses are for treating adults.

DEPUTY COMMISSIONER SEAGULL: Yeah, we definitely agree that it should be done and that's the certainly the intent of how this is written, so in the definition of a debilitating medical condition for those 18 and over and there are a separate list of conditions which is narrower for those 18 and under in addition returning to the Board of Physicians, that bifurcated as well so, we would request from them a recommendation on each condition whether it should be for the adult list or for the kid's list but certainly if you think it needs to be clarified further.

REP. CANDELORA (86TH): Okay, I'll read it again. I didn't get that gist when I first read the bill.

DEPUTY COMMISSIONER SEAGULL: Okay but certainly that was our intent.

REP. CANDELORA (86TH): Thank you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you Representative Candelora. I think Representative Srinivasan has some questions.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Deputy Commissioner and Commissioner sitting back there, for your testimony and for all the work that you have done to make this program, as functional as it is. And I know from what I've heard, we are a model for the rest of the nation and everybody else is looking as to how to duplicate what we do in Connecticut, and you both have played a significant role from what we have passed here to make it happen. So we really appreciate about that.

DEPUTY COMMISSIONER SEAGULL: Thank you.

REP. SRINIVASAN (31ST): Having said that, could you elaborate a little bit on what you had in mind when you talk about research in terms of what kind of research are they looking at, A. And B, are there other places in the nation that have done research on marijuana?

DEPUTY COMMISSIONER SEAGULL: So for the first part of the question, we don't have a precise idea in mind. Certainly one of the critiques or concerns with medical marijuana generally is the absence of research. So we would like get it moving in that direction. And what we have in Connecticut is all the products are being -- they're being kind of produced in laboratory tested, labeled with active ingredients. So you really have replicable products that could then really be tested on specific disease states.

There are different ways and we've certainly heard people discuss different ways to set up a research program to do that. So we'd be open to different ideas whether it's to test on a specific disease state. Some people have paused and the opioid issue is obviously of high concern to everyone. Is the research that can be done to see to what extent this could be an exit ramp to a degree for people who are maybe taking heavy pain medications to switch them over to this product?

So there's a range of ways, so I wouldn't try to limit that. We would expect it to be done. This is not something that anybody could do. It would be done either with one of the licensees who have the access to the product or medical or research, academic, you know for example an institution.

As to other places in the country, there is certainly some going on in different places. I think Connecticut is best situated for this because of how we have the really pharmaceutical model so you can do testing on a product that s the same over time and that you have a label on. Certainly other countries although outside the United States they are doing very serious research as well. So it is going on.

REP. SRINIVASAN (31ST): Thank you very much. I was some time back, I think at the end of last year, I had the opportunity of going to Maryland, which was one of the places I think that was and you know when you were looking for three more and the state was deciding whom to give the license to, three more producers or whatever we called them. I heard that Maryland was one of them. I went to that place to visit their plant and they had talked about research there, and I was always curious as to what kind of research was being done?

So you're looking at a product in terms of you know whether the same product is going to be duplicated every single time in terms of potency. You're looking at those as a research model or the clinical efficacy like we do in medical research?

DEPUTY COMMISSIONER SEAGULL: Certainly either, I mean the idea would be to get to the double blind type of studies and start moving on a pathway to create a parallel to what's done federally with other pharmaceutical products. So that would you be the idea, just given the federal issue and the difficulty of research we certainly wouldn't limit research to only those types of studies. So it could be yes, specific dosage forms. It could be looking to different ways in terms of delivery methods to what extent are there benefits to maybe an edible product as opposed to a vaporized product or different things along those lines. So, we would really let sort of the experts in research come to us with proposals and then if they made sense, and they were going to remain consistent with the medical model we have designed, those would be the types of research programs we would approve.

REP. SRINIVASAN (31ST): Thank you very much. And thank you for the thousands of lives that you have improved because of the model that we have here in our state. Thank you very much.

DEPUTY COMMISSIONER SEAGULL: Well, thank you very much.

REP. SRINIVASAN (31ST): Thank you. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Are there any other questions? I have a quick one, the Board of Physicians that is set up in statute, are they an advisory council or a policy making council? I guess I want to understand that a little bit better.

DEPUTY COMMISSIONER SEAGULL: They're role is primarily to review and advise or make recommendations to us.

SENATOR GERRATANA (6TH): I see okay, so I would consider that more advisory rather than policy?

DEPUTY COMMISSIONER SEAGULL: Right, so they can't, they can't implement changes that were from -- yes.

SENATOR GERRATANA (6TH): Right, they can make recommendations and advise.

DEPUTY COMMISSIONER SEAGULL: Correct.

SENATOR GERRATANA (6TH): Okay, thank you so much. Thanks for coming today and testifying.

DEPUTY COMMISSIONER SEAGULL: Thank you.

SENATOR GERRATANA (6TH): Okay. I understand Stan Gold is back, perhaps? They had called his name before? Maybe not. Okay, and we'll go onto Ruth Canovi, followed by Jeanette Weldon.

RUTH CANOVI: Good afternoon distinguished Chairs and members of the Public Health Committee. My name is Ruth Canovi, I am the Manger of Public Policy for the American Lung Association in Connecticut. I apologize for you not having written testimony in front of you, that went in after the deadline but you will have that available to you after the hearing today.

I am here to support House Bill No. 5463, AN ACT CONCERNING SMOKING IN VEHICLES, as well as Senate Bill No. 290, AN ACT CONCERNING THE SALE AND PURCHASE OF TOBACCO PRODUCTS, among many other things. Both re within the context of a larger public health policy to address tobacco, which is still the leading cause of preventable death and disease in Connecticut. Connecticut loses 4900 people annually to tobacco. The state spends more than $2,000,000,000 in tobacco related healthcare costs every year. We can and must do more to address the devastating impact tobacco has on our public and physical health.

I had the privilege of sitting on Speaker Sharkey's task force on the issue of smoking in cars with minors present. And I thank the speaker for convening the task force, and the Co-Chairs, Genga and Kokoruda for their leadership on this issue of reducing second hand smoke exposure for Connecticut's children.

Connecticut has worked hard to protect adults in the workforce from the dangers of second hand smoke. The fact is there is no risk free level of exposure to second hand smoke and we must do more to protect young kids as well as those excluded from the protection of indoor air laws from the impact of this pollutant.

Second hand smoke contains hundreds of chemicals known to be toxic or carcinogenic and causes more than 41,000 deaths annually. It can cause or make worse a wide range of damaging health effects including heart disease, stroke, lung cancer, respiratory infections and asthma. As that's been the case, when considering new legislation related to tobacco, this proposal has generated some controversy. We support the recommendations put forth by the task force to address some of the enforcement concerns such as the probable cause language that can be inserted with this piece of legislation. And we welcome the opportunity to further discuss concerns about enforcement of this law. This policy is not something that we take lightly, we know it's controversial but this policy is not about prohibiting an adult's ability to smoke while in their cars by themselves. It's about protecting the freedom of children to breath healthy air and develop healthy lungs into adulthood.

Levels of air pollution in a car even if windows are open, get incredibly high, incredibly fast. It's been shown that one smoker can emit 50 times more fine particles into their car when smoking than those emitted by the tail pipe per mile in the cars. And to answer a question that came up, DPH's website cites concentrations for second hand smoke in a car with no ventilation has been shown to be 27 times greater than in a smoker's home.

So I have also submitted testimony regarding Senate Bill No. 290 and the Lung Association supports raising the age at which tobacco can be sold to people, to 21. Ninety percent of adults who start to smoke, started by the age of 21, and half of became regular smokers by their 18th birthday. A recent report from the institute of medicine found that raising the minimum age for tobacco sales to at least 21 years old, would significantly reduce smoking rates and they have projections that could really make a big public health impact.

So one last thing in closing I guess I'd say, as you look to address our state's efforts to reduce the impact of second hand smoke on youth, we hope you take the opportunity to take a broad look at the many ways we can improve Connecticut's public and physical health. So, thank you.

SENATOR GERRATANA (6TH): Thank you Ruth. Thank you for your testimony. As usual very good. Are there any questions? If not, thank you so much for coming today.

RUTH CANOVI: Thank you.

SENATOR GERRATANA (6TH): Next we have Jeanette Weldon, to be followed by Connie Dills, I believe. Hey.

JEANETTE WELDON: Hi good afternoon Representative -- uh, Senator Gerratana and Representative Ritter. I'm very happy to Be here today. My name is Jeanette Weldon and I'm here speaking on behalf of the Connecticut Health and Educational Facilities Authority also known as CHEFA to offer testimony in opposition to raised Bill No.5454, AN ACT CONCERNING THE CONNECTICUT HEALTH AND EDUCATIONAL FACILITY AUTHORITY.

CHEFA is a quasi public agency that issues tax exempt revenue bonds on behalf of Connecticut's not for profit hospitals so that they can access lower cost investor dollars to fund capital projects. Raised Bill No.5454 seeks to enhance the ability of community hospitals to attract private investors, by allowing these hospitals to issue tax exempt revenue bonds with state backing through a special capital reserve fund, which is a type of debt service reserve fund.

I am testifying against raised Bill No.5454 based on concerns raised by the administration in particular the reduced role of the office of policy and management and the office of the treasurer in reviewing the credit worthiness of these institutions that qualify for the special capital reserve fund and the increased likelihood of a draw on that fund. The proposed bill also gives CHEFA the authority to provide financing to projects outside the state of Connecticut when the borrower is a Connecticut entity. CHEFA is generally in support of this specific provision and previously submitted a separate bill in this regard. We believe that this provision may help secure a role for the state in the out-of-state activities of it's healthcare systems.

Thank you for your time and I would be happy to answer any questions.

SENATOR GERRATANA (6TH): Thank you so much. My co-chair Representative Ritter has some questions.

REP. RITTER (1ST): Just quickly, thanks for your patience, I know it's been a long day. So just, just to be clear. So the part that would be amending, just looking at the bill, you are looking -- you would like authorization to be able to do some projects that might be out of state, that relate to health systems that you finance projects who are currently in state, is that correct?

JEANETTE WELDON: Yes, when the borrower is a Connecticut entity, the project is out of state.

REP. RITTER (1ST): Okay. It's the other stuff that got tucked in that has you submitting opposition to the bill?

JEANETTE WELDON: Correct.

REP. RITTER (1ST): Not the bill in its entirety?

JEANETTE WELDON: Right, so the provision with regard to the financing of projects, that piece we support. The rest we are in opposition to.

REP. RITTER (1ST): Alright, just so we're clear. And sometimes for the sake of expediting the process, which as you see today, can drag on and we sometimes smush ideas together for public hearing purposes, got it. Thank you.

JEANETTE WELDON: Okay.

SENATOR GERRATANA (6TH): Thank you. I don't think anyone else has questions. Thanks so much for that clarification. Next, we go to Connie Dills to be followed by Senator Martin Looney. And then we're going to Bryte Johnson, and he will be followed by Representative Joe (indiscernible). Hi.

CONNIE DILLS: Good afternoon.

SENATOR GERRATANA (6TH): Welcome.

CONNIE DILLS: Thank you. Good afternoon Senator Gerratana and Representative Ritter, and members of the committee. My name is Connie Dills and I am the President of Connecticut Society for Respiratory Care and the Respiratory Practice Manager at Hospital for Special Care. I very much appreciated the opportunity to participate in the smoke exposure to Minors in Vehicles working group over the last four months. And our members support H.B. 5453, AN ACT CONCERNING SMOKING IN MOTOR VEHICLES. As is well referenced in the report, the harmful effects of second hand smoke has been extensively studied and validated in addition to the toxins and carcinogens present in airborne tobacco smoke that are inhaled by all passengers in the vehicle including children. These same toxins and carcinogens deposit in residual form into the upholstery and onto other surfaces where children touch and then as all children do, put their hands in their mouths thereby ingesting them through their oral mucosa. Also children are exposed to cigarette smoke are more likely to develop asthma and bronchitis. Children are captive audiences in motor vehicles. They do not have the ability to remove themselves or refuse being exposed to this type of hazardous environment. The environment inside a vehicle where tobacco smoke is present is contained, very concentrated and dangerously high in carbon monoxide. I urge you to review the report and references documents submitted by the working group and make your informed decision for helping protect the children of Connecticut from developing preventable, chronic respiratory illness. Thank you.

SENATOR GERRATANA (6TH): And thank you so much for your testimony, we appreciate it. Are there any questions? I guess not. Thank you for coming today. Let's see, I don't see Senator Looney but Bryte you can come up.

BRYTE JOHNSON: Hi, good afternoon, Bryte Johnson, State Director of Government Relations for the American Cancer Society Cancer Action Network. We've submitted longer testimony on S.B.290, but I'll just cover some quick point. Increasing the minimum tobacco sale age in Connecticut from 18 to 21, it's a promising intervention and is definitely worthy of discussion and we appreciate the committee granting a hearing on this issue.

In March 2015, the Institute of Medicine released a report indicating that if the national minimum legal age was raised to 21, it would be predicted to reduce smoking prevalence by about 12 percent nationwide, and smoking related deaths by nearly 10 percent nationwide. Those are huge, huge numbers so that's certainly eye-opening and worthy of discussion, however, it's not as simple as just going into statute and every time you see the word -- the number 18, crossing that out and replacing it with 21.

Because this is a relatively new concept across the country. There is not yet a lot of evidence to support the effectiveness which is not to say it shouldn't be done, it's just to say that if we are going to do it, that we need to do a number of things to strengthen it including adding a -- an evaluative component so that the research can be conducted and so that these numbers will go into the larger body of research on the issue.

Additionally the focus of this should be on increasing the minimum age of sale, not the minimum age of purchase. Laws prohibiting sales to minors have historically not been that effective as stand-alone measures. And we want to make sure that minors are not the only ones that would be -- that would bear the brunt of any sort of punishment punitive punishment for trying to purchase cigarettes when it works both ways the people that are selling the cigarettes share a burden of, a little bit of that burden as well.

One other thing to consider is that most of the statutes that are in this bill to be amended are over 20 years old, and they themselves are in many cases horribly, horribly outdated. So we would actually recommend that if you're going to look at this, let's look at it -- let's look at all the statutes that this bill addresses because some of them, for example pertaining to vending machines are woefully, woefully out of date, and just changing it, just to change it isn't necessarily going to improve at the public health of the state.

And then finally stated earlier, this one component but the larger issue is that the State of Connecticut is dedicating zero dollars to tobacco control. And while we're not weighing on smoking in cars, other than to say that of course we support the idea, the reality is that under no scenario that we worked on as part of the working group, could we come up with something that didn't involve an educational, the need for an educational component. And how do you pay for an educational component with no money?

So the bottom line is, these are good ideas. These are ideas worthy f discussion, but the bigger issue is that we have zero dollars dedicated to tobacco control in this state.

And let me just finish by reading something that I read every time, like think about this -- think about this, tobacco use in Connecticut kills more people every single year than alcohol, AIDS, car crashes, illegal drugs including heroin and marijuana, accidents, murders, and suicides combined by nearly a 2:1 ratio, every single year. And our response is to spend zero dollars on it. Thank you.

SENATOR GERRATANA (6TH): Thank you. Thank you Bryte, always great testimony. We appreciate it. I don't think anyone has any questions but thank you for giving your testimony today. Okay, let's see we have both Senator Martin Looney and Representative Joe (indiscernible) I guess when they come down then they can testify. Right now will be Jim Williams, followed by Anthony Holdomph, I believe? And that depends on whether Senator Looney or Representative -- come.

JIM WILLIAMS: Good afternoon, my name is Jim Williams I'm the State Government Relations Manager for the American Heart Association. In recognition of all who have come here today to testify and with the committee's permission I'd like to testify on two individual bills within my allotted three minutes.

The first bill I'd like to comment on is this bill, Senate Bill No.290, AN ACT CONCERNING THE SALE AND PURCHASE OF TOBACCO PRODUCTS, ELECTRONIC, NICOTINE DELIVERY SYSTEMS AND VAPOR PRODUCTS AND SINAGE CONCERNING THE USE OF SUCH PRODUCTS AND SYSTEMS.

Heart disease is the number one cause of death in the United States and in Connecticut, and smoking is the number one cause of heart disease. 480,000 state residents or 18.4 percent of the adult population use some form of tobacco or one or more in the past 30 days in an estimated 4300 adults die in Connecticut each year as a result of their own smoking. Currently, 13.2 percent of Connecticut high school students smoke and 2100 kids under the age 18 become new daily smokers each year. 56,000 kids who are now under the age of 18 will ultimately die prematurely from smoking.

Smoking during adolescence increased the risk of long-term addiction to nicotine. Most teens who smoke and use tobacco report getting cigarettes and other products from their friends, 90 percent of those who provide cigarettes to younger teens are under the age of 21. Increasing the sales age will limit high school and middle school use access to addictive products from older teens.

The second bill that I wanted to briefly comment on, is Senate Bill No.296, AN ACT CONCERNING THE REVISION FOOD IN VENDING MACHINES OPERATED ON STATE PROPERTY AND RECOMMENDATIONS OF THE CHILD OBESITY TASK FORCE. There is no doubt that we are in the midst of an obesity crisis, 37 percent of Connecticut's adults are either overweight or obese. Diet related diseases such as heart disease, diabetes, cancer stroke, and osteoporosis are leading causes of disability and death. Diet related diseases increase healthcare costs to the state, businesses and individual citizens. In Connecticut close to $1,000,000,000 in healthcare costs are attributable to obesity. Including $246,000,000 in Medicare costs and $419,000,000 in Medicaid costs. The obesity epidemic has also impacted Connecticut's children. According to the November 2015 Department of Public Health, Every Smile Counts Obesity survey, 26 percent of Connecticut's high school students are overweight or obese. And 32 percent of students in kindergarten to third grade, are overweight or obese. Regarding Section 1 of this bill, it does not require changes to which foods and beverages are made available on state property. It does however, require an assessment, which we feel is a good first step so that we can all better understand he current landscape and how any changes might impact any concerned parties.

We do have a number of specific language requests for Section 2, that are clear in my written testimony that we feel would make this a better bill.

To conclude I would like to thank again the committee for their time and this opportunity to speak with you today. We gladly collaborate with any interested or groups to make this bill better and I'm happy to try and answer any questions that the committee may have either now, or after today's hearing. Thank you.

SENATOR GERRATANA (6TH): Thank you Mr. Williams. We appreciate so much your testimony on both bills. I don't think there are any questions, so thank you for coming today.

JIM WILLIAMS: Thank you.

SENATOR GERRATANA (6TH): Next we have Senator Lynn Fasano, Senator Fasano. We're still waiting for Senator Looney and Representative (indiscernible) Senator Fasano, followed by Anthony Holdomph, and Representative Ackert is after Anthony. Is Anthony here? Okay, then we'll go onto Leslie Simoes. Yeah, you're the next member of the public -- that's okay, and then Representative Ackert is after you. Hi Leslie.

LESLIE SIMOES: Hello and thank you.

SENATOR GERRATANA (6TH): Sure.

LESLIE SIMOES: Thank you Senator Gerratana, Representative Ritter and members of the Public Health Committee. My name is Leslie Simoes and I'm the Executive Director of the ARCH of Connecticut, a 62 year old advocacy organization dedicated to promoting and protecting the basic civil rights of individuals with intellectual and developmental disabilities. You have my formal written testimony in front of you, including the proposed original language of that the Arc worked pretty hard on, and the memo that we submitted to Representative Demicco. And so I'm just going to summarize now. Really first of all thank you all so much for listening to families in an extremely difficult budget year that is fraught with massive deficits and looming cuts that are going to hurt families. This bill will provide families and individuals the information they need to know about the status of their relationship to the Department of Developmental Service Services.

As we heard earlier, there seems to be a lot of confusion around this proposed language. And what I can offer you is what the Arc proposed and what we had envisioned, what we were calling our Family Rights Bill, and again that proposed language is part of my testimony today.

The language outlined, you know what we asked for and where some of the other language came from, we're not really quite sure about, but in my formal testimony I offer or Arc offers some suggestive revisions and we hope that you take that, under consideration. The commissioner this morning testified and acknowledged that there is a training issue with her staff at DDS and that the DDS database is not accurate. She also appreciated the frustration that families feel when dealing with the policies within the department, and so a little bit later you're going to hear from many of the families that we work with who are really, you know my mentors and certainly my heroes and you'll hear about you know some of the exact nature of the impact that the department and having unclear guidelines and practices around how they share information on how that negatively impacts our families and so I thank you for the opportunity to testify and I'd be happy to answer any questions. I tried to be very brief, since you already have all of my written testimony.

SENATOR GERRATANA (6TH): Yes, and I've been reading through it. Thank you Leslie so much. Are there any questions? Representative Demicco.

REP. DEMICCO (21ST): Thank you Madam Chair. Leslie, thank you for coming and testifying. I, I -- since you're closer to ground level on all this than I am or the committee members are, I was wondering would you be able to expand a little bit on some issues that came up this morning. For example, the commissioner right from the outset, indicated that Bill No.294, which is the bill we're talking about today, is it really necessary because most of the things if not all the things that are in this bill are already being done by the DDS. So, would you be able to comment on that, and maybe offer your opinion on that?

LESLIE SIMOES: Sure, you know I can't speak for every family in the state of Connecticut, but we do receive many, many phone calls on a weekly basis and have for many, many years. And so we do get to hear from families about how the system breaks down for them in particular, and you know for instance there is a process within the department it's called the PRAT Meeting, I believe it's a program resource allocation team. And family if they need an increase of their budgets go to this team at DDS to petition to say that there's been a change of status in their family and they need more resources. They're not even allowed to go to that meeting. Oftentimes, their case manager isn't even at the meeting but the case manager writes up a report or a request. The meeting happens, the family is notified either yes or no.

SENATOR GERRATANA (6TH): Excuse me Leslie, I'm interrupting you but is there anyone here from DDS?

LESLIE SIMOES: Christine is.

SENATOR GERRATANA (6TH): Oh yes, good. That's excellent, I'm sorry I couldn't see you. Perhaps the commissioner could answer that particular protocol that Leslie raises. I, you know legislature is kind of biological in many ways. You know we try to address these kinds of concerns as we go along and you know I'm sitting here going how am I going to write this bill, so. This would be very helpful. And, please continue I'm sorry to interrupt but, the points that you're raising I just wanted...

LESLIE SIMOES: Oh okay. No, that's okay.

SENATOR GERRATANA (6TH): DDS to be aware of and then we can have further discussion. Thank you.

LESLIE SIMOES: And we work really closely with the department on different issues.

SENATOR GERRATANA (6TH): I know you do.

LESLIE SIMOES: And we're speaking with Christine today about this very piece. So, this, this meeting happens and families are added, and their case manager sometimes isn't even at it. Yet this request goes in for an increased resource allocation and they are told either a yes or a no. And many, many, many times I can't say always, I can't say for sure but many times the families are not given a reason why the resource allocation was denied. But they are given a process to appeal but how is the family supposed to appeal a decision that they don't know what the decision was based on. So this is one of the pieces that we really wanted to have included in this bill which in the final draft that just came out actually isn't, and which is unfortunate. But those are the, you know that's an example Representative Demicco, that's helpful.

There are times when families are not given copies of a LAN. The commissioner spoke this morning about a level of need assessment. It's a very long document and it's supposed to go through the individual's abilities, what they need support with, etcetera. And oftentimes families don't even see that document. They're supposed to actually fill it out with their case manager. Oftentimes that doesn't happen. The case manager is just filling it out, submitting it. That document is really important because that document is the one that actually determines what the funding level will be. So that's a really important document to know if you're a family member, the future of services for your child is based on a document like that, without knowledge.

So there is many examples and I have families who are going to testify after me who can really give you some more examples.

Is that enough Representative, I mean? And so, so what the commissioner was saying is true that they do have some policies and procedures in place that re supposed to happen, but in practice and in actuality that doesn't always happen. And it leaves families at an extreme disadvantage, and in a time when they're being told there's no money in the system, and they have to wait until they die or the last caregiver in their family dies in order to get services. Having a little more information from the department would be really, really helpful.

REP. DEMICCO (21ST): Thank you. I just want to ask you one other question. I'm looking through your testimony on line now. and you would made several recommendations to make this bill a better bill. And the first recommendation had to do with the waiting list. So I take it you're not satisfied with the waiting list definition that's given in this, in this bill and you'd like to see it -- you'd like to see it changed?

LESLIE SIMOES: Well, we're not satisfied that there's a waiting list at all, let's be frank. I mean you know the fact that families are having to wait for services is, is obviously a problem. The bill is as we intended wasn't necessarily to discuss the waiting list or to talk about Southbury. There's a big Southbury piece in there, which you know we don't think should be in there. But to work on redefining the waiting list at this point, is a little premature. There's a couple of things going on right now. The department, they're doing a study, well it's not even a study, it's a working group that's been assigned to look at the definitions, the commissioner spoke about that today. And there's some pretty significant definitions that were formed a number of years ago when the Arc followed the waiting list lawsuits, that outlines what the definitions are of the waiting list.

I just, at this point, it may not necessarily be the time to be looking at that. The waiting list issue as a whole in Connecticut absolutely has to be addressed both definitions and the funding and everything. In fact the governor convened almost two years now, a waiting list working group, that has yet to come up with any recommendations. And so the waiting list is really important but for this particular bill, I was really about a family's rights though and the transparency in the system. And so defining the waiting list at this point, isn't necessary we think. But, if the committee really feels that they need to, we would definitely want to propose the following revision, which is, the waiting list maintained by the department that includes the names of individuals with intellectual disability who have requested residual day support or any other services from the department, and have either not received or received insufficient services. The department shall maintain separate lists for each service.

So, that's what we would propose if the committee is really attached to doing this. But, you know -- and also to like the Southbury language, I don't know how that got in there. Obviously, it's the Arc, we want Southbury closed. We want the governor to use his executive authority and close it, absolutely. We have the Messiah Agreement as you all know about. But I don't know how that got in there. The legislature passed a bill, the Deficit Mitigation bill on December 8th, that included similar language, so I'm not sure why that's in there.

REP. DEMICCO (21ST): Notwithstanding that, I'm not sure either but I guess we'll find out eventually. But if I may ask two other quick questions, Madam Chair? Okay, again I'm looking at your recommendations Leslie, one of the recommendations is that the department shall annually notify each individual of the individual's priority status and the amount of funding budgeted for each service provided by the department. This annual notification shall include the individual's up-to-date Level of Need Assessment. So, does that not currently happen, based on your experiences with families?

LESLIE SIMOES: Pieces of it happen but not all of it happens. And so that's I think -- and obviously that's why we're recommending that, that be included. Again, some of these pieces are in their policies right now. Some would be new policies that we're trying to create. And we do really want to work in partnership with the department too on this because if families have access to accurate information, they're not going to be in the system in a way that causes you know, that eats up more time and resources, if they actually have the information that they need.

Which recommendation was that, Representative Demicco? I'm just looking and I want to make sure that --

REP. DEMICCO (21ST): I think I was -- I think I was your third recommendation if I'm not mistaken.

LESLIE SIMOES: Okay, oh wait. So the -- once every three years. Well right now, the waiting list is currently updated quarterly anyway, so to go to anything over that seems -- that doesn't necessarily make sense, since it is already updated quarterly. And you can see the reports that they give in the management information reports which are -- the commissioner spoke about but they're on the DDS website and they are really a great source of information about what's happening at the department with very, you know with statistics. Did I answer the question? I'm sorry if I --

REP. DEMICCO (21ST): Yes. And I guess the final one is your very last recommendation that the department shall provide copies of any document used by the department that in whole or in part forms a basis for the department's decision. Again, is that a problem right now?

LESLIE SIMOES: Yeah that, that actually has to do with the example I gave about the PRAT Team. Any decision about funding for an individual really needs to be given to the family or the guardian, you know their legal guardian, so the family can make a informed decision about whether or not that's accurate. If they'd like to appeal, there's a variety of reasons why that needs to happen and it's not common practice at this point that I am aware of.

SENATOR GERRATANA (6TH): If I can inject again, why aren't those -- these are not medical records because I know you're making a recommendation regarding HIPAA. If they're not medical records aren't these records subject to Freedom of Information? I don't mean that every parent should have to go through the FOI process knowing of the other challenges that they have to deal with, but why aren't these so called records or documents forthcoming, I mean if I request them and someone I'm caring for is receiving services or even if it's the person who is receiving services, why wouldn't they get this information?

LESLIE SIMOES: That's a very good question.

SENATOR GERRATANA (6TH): And why do we have to put that into law, and I don't know. I guess I'll look for a response from DDS on that.

LESLIE SIMOES: Well I'm not a lawyer and I'm not familiar with Freedom of Information, and I'm not you know, I'm not a Freedom of Information, however --

SENATOR GERRATANA (6TH): No I, I understand that but I'm saying they're public records more or less, I don't know how they're protected.

LESLIE SIMOES: These documents do have identifying information and then they'll have the diagnosis, they'll have you know, their support needs and so they could maybe be you know, determined that they could have identifying information that might fall into some sort of a HIPAA, but if it's the individual themselves and they're their own guardians they should be able to have access to them. And if their guardian -- if they have a legal guardian then they should be able to have access to them. So, I really think it is that simple senator, that -- and I don't know why they're not offered that.

SENATOR GERRATANA (6TH): And also, so that you know, we pass law last year, patient records are the property of the patient so any medical records that anyone has from a provider in the state, it is the property of the patient. Just to make that clear. That's something that I thought was very important going forward in this state, that we acknowledge that if you are treated in any way in a medical setting, in a medical setting, that those records are your records. That you have to pay for them, or you can get a summary from them. But -- and the provider can provide them. But they are your records, just so you know.

LESLIE SIMOES: Right, and that's very helpful and you know we look forward to working with the committee and with DDS on ways to maybe try to figure out how we can get that information to families while not violating any particular you know laws that might be out there. It is an important piece of information for families to have.

REP. DEMICCO (21ST): Thank you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you so much. Are there any other questions? If not, Leslie thank you for coming today. Representative Ackert.

REP. ACKERT (8TH): Thank you. Good afternoon Chairs, Senator Gerratana, Representative Ritter, ranking members Dr. Srinivasan and esteemed members of the committee. My name is Tim Ackert and I represent the 8th District which includes Columbia, Coventry, Vernon and Tolland. Thank you for the opportunity to appear before you to speak on Senate Bill No.290, AN ACT CERNING THE SALE AND PURCHASE OF TOBACCO PRODUCTS, ELECTRONIC NICOTINE DELIVERY SYSTEMS AND VAPOR PRODUCTS AND THE SIGNAGE CONCERNING THE USE OF SUCH PRODUCTS AND SYSTEMS.

I'm here to specifically speak on raising the age for the purchase of tobacco products. I believe it's time Connecticut takes a proactive approach to reducing smoking and the best ways to keep those at an impressionable age from starting. As we age and get more mature, we make better health decisions and the decisions not to smoke leads to a healthier lifestyle. Additionally, the economics of not smoking free up income for other financial obligations. I know the question may rise, what would the impact have on Connecticut's budget for not collecting sales tax for the sale of tobacco products from these young people. I believe it's a positive impact toward the overall state economics to have healthier people that can make greater positive contributions to society. The state is made a true push to reduce smoking with the funds received from the tobacco settlement. These funds have been used to balance the budget, rather than it's intention to discourage people from smoking.

I hope you will look favorably by raising the age of the purchase of tobacco products as Hawaii did and many prominent cities like Boston, Cleveland, Kansas City and New York City have. And I hope that Connecticut takes the approach, you know there is a lot of places to look at. Tobacco 21 dot org has some great information info on that, and you know some of the research out there states that we make this approach t raising it to 21, we'll have three million less smokers in this country and I think that's an opportunity for us to take advantage of that.

I would like to comment also on two other bills before you today, in support of H.B. 5450 on the palliative use of marijuana, I'd like to -- I support that legislation that you've brought before you. Also again, I'm supporting House Bill 5453, smoking in cars. I think sometimes in our lives you know, having a grandchild whose mom smoked, this bill became very prominent for me to say you know, I don't want that child to have smoke in the cars if you have little ones, so. And on House Bill 5450, sometimes when people close to you have health issues, that we believe that this can help. Another comment on that bill though, having -- I know this individual that is suffering with cancer, talk to their doctor about the palliative use of marijuana and the doctor was concerned about the federal aspect and that's why she said that until the research is done -- so I think this approach that you have on the bill regarding research is truly important, and I thank you for raising that bill and putting that in it. So we'll look forward to any comments that you may have or questions you may have on the age of -- raising the age of tobacco. So thank you for the opportunity.

SENATOR GERRATANA (6TH): Well thank you for your testimony That's wonderful I'm glad you testified on all those bills. All our good public health, proactive public health bills. I think Representative Srinivasan has a question for you.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Representative Ackert for your advocacy on A, that one bill and your comments on the other blood loss, and we appreciate that. We heard earlier that the amount of taxes that you alluded to that the state might lose because of the changing of the age from where we are to 21. And somebody gave us very a very interesting statistic as to the amount of taxes we get, A. And the amount of money that we spend on the long-term basis. And that obviously taking care of these people who have smoked and continue to smoke for that length of time. The permanent impact and I was quite an eye opener as to the amount of taxes we collect is miniscule compared to what we could be spending on their healthcare. Whether it be the state level or the private insurance regardless. Somebody is footing that bill and it's a huge amount. So I think raising that rate -- age would play a significant role in reducing the number of people who are smoking, A. And as you very correctly said, at an impressionable age, and as we get a little older and get grey hairs that you and I have, you know we probably make better decisions than we did when we were at age 16 and 18 ourselves. And so it would make a difference. Thank you very much bringing this bill in front of us, and we appreciate all of your comments.

REP. ACKERT (8TH): Thank you doctor, and thank you, and just a follow up if you don't mind. I do believe I think one of the times, when you're in high school and that's the age when you can typically buy these products is that, you know we look at peer pressure and what others are doing and once we get out and into an area where maybe we go onto higher education or jobs it becomes less prevalent that people start at a later age. So again, I thank you for the opportunity to speak on this, and look forward to your good work that you continue to do on this committee. Thank you.

SENATOR GERRATANA (6TH): Thank you. Next we have Shelah McClure followed by Marina Derman.

SHELAH McCLURE: Good afternoon Senator Gerratana, Representative Ritter and members of the committee. Thank you for the opportunity to testify in support of raised Bill No. 294. My name is Shelah McClure and I'm Chair of the Connecticut Council on Developmental Disabilities, which is a public agency whose mission is to promote independence and full inclusion of people with developmental disabilities in their communities. I'm also the parent of a 25 year old son with an intellectual disability who lives at home with my husband and me.

First and foremost, the council thanks you for raising this bill, it contains a number of important proposals although the council does suggest that the bill can be improved with some modifications. I submitted my testimony electronically so I just would like to focus on a couple of points.

We believe that the definition of the waiting list in the bill is too narrow especially in it's limitation of -- in Section 1A 3B to those in urgent need for the services requested. I included a link in my testimony to the December Management Information Report by the Department of Developmental Services and if you look at pages 15 to 17 of that report, it goes into the waiting list and the planning list of the department. And you will see that the definition that's proposed in this report -- proposed in this bill, would really end up with a waiting list of about 32 people, down from what currently is on the December list of over 900 people. So it really ends up in a dramatic under, really understatement of the waiting list problem that faces this state. And truly from the advocate's point of view we have a waiting list of over 2000 people when you include those that are on the DDS planning list as well. So we don't believe that, that definition of the waiting list should be followed.

And I heard Leslie read into the record -- read into the record a proposed alternative definition which is the definition we agree with.

I would also say when it comes to waiting lists, the department up until actually a couple of years ago, was reporting on a day services waiting list. They now have a waiting list for day services again. I think the department ought to be reporting on all of it's waiting lists. They do report on their autism services waiting list, but they ought to report on their day services waiting list. They ought to report on the respite waiting list. So that the General Assembly and the public knows whether the needs of all people with IDD, their needs are being fully met.

The other thing I would say is --

SENATOR GERRATANA (6TH): Yes, can you summarize for us please?

SHELAH McCLURE: Sure.

SENATOR GERRATANA (6TH): Okay.

SHELAH McCLURE: My, additional points are made in my electronic testimony. I would just like to say with respect to Section 2, of the bill the council appreciates that you've added us as a stakeholder in the December Special Session process with regard to Southbury Training School. We would recommend that you add as an additional stakeholder, individuals and family members on the DDS waiting list.

SENATOR GERRATANA (6TH): Did you include this in your electronic

SHELAH McCLURE: We did.

SENATOR GERRATANA (6TH): Oh good, good because we'll -- that, in writing it's very important because we consider that when we look over testimony.

SHELAH McCLURE: Okay, I just want to make the point that those individuals who are not currently on your list as stakeholders, we believe have as much a claim to DDS services as those who currently get serves, and there ought be -- they ought to have a role.

SENATOR GERRATANA (6TH): Good, good.

SHELAH McCLURE: And they ought have a role in that process.

SENATOR GERRATANA (6TH): Got it. Thank you so much. I don't think anyone has any questions, no. Oh wait a minute I'm sorry, Representative Demicco has a question.

REP. DEMICCO (21ST): Thank you Madam Chair, thanks Shelah.

SHELAH McCLURE: Sure.

REP. DEMICCO (21ST): I would just like to, wanted to give you an opportunity because in your testimony you talk about priority status? Would you be able to give us just a brief summary of that?

SHELAH McCLURE: Sure, so there is a definition that's proposed in the bill for priority status. And to our knowledge the only reason that the department uses that is for purposes of the waiting list. So I just think that it would make sense that if priority status is going to be a defined term in the bill, that it ought to be clear that, that's the purpose that they are using it for. Is for the purposes of any waiting list that the department maintains. Without that I think it's sort of hanging out there without being clear why they're assigning a priority status, okay? Thank you.

SENATOR GERRATANA (6TH): Thank you. Next is Marina Derman, followed by Sue Bastein.

MARINA DERMAN: Good afternoon Senator Gerratana, Representative Ritter and members of the Public Health Committee. I thank you for making time today to hear us. I am here today in support of Bill S.B. No.294. My husband and I have two sons, both of whom have autism and intellectual disability. One of my sons is lucky enough to have a residential placement in a group home because of a history of severe and violence and aggressive and self injurious behavior. And the other is priority one on residential waiting list. So I speak here today to you, knowing something about this problem and caring deeply about it.

For most of this bill I will stand along with the testimony you've heard already from Leslie Simoes of the Arc and say we as families agree with greater transparency, greater information, greater understanding. I will differ with her on the importance of analyzing the waiting list. To me, this bill is a vital first step in solving the problem of the DDS waiting lists because as Shelah just said, there is a residential waiting list, which you have all heard about for several years now. It is a growing problem. There's also newer waiting lists for day services, for in-home supports, for respite, and to get into the behavioral support program formally VSP, to get into the autism program, etcetera.

There are those who say, we don't need a bill like this. And I say, how can you solve a problem if you don't fully understand it? The information DDS currently has on the residential needs of it's families is outdated and inaccurate. We speak to families every day who have never been asked whether they want to put their child on the residential waiting list. Whether it's for as soon as possible or whether it's because they want to plan for something 10 years from now. They have never had an opportunity to even make that choice because it's never been discussed with them.

And on the other hand, we also know that some families who offered residential placement several years back with the caregivers over 70 funding that occurred, actually wanted something different which was discovered when they were asked at that point. So this current waiting list as it stands people on it who should not be, and people not on it who should be. So the first step to understanding the actual needs would be a census of all DDS individuals with their families and update this list annually because things change, our kids change, our situations change, and DDS's offerings change.

Updates are easily done. There's an annual individual planning meeting for each person anyway. So updating on situations going on with the family are easily done on the annual rolling basis, after an initial baseline census is done.

But also please consider the following suggestions for amendments to this bill. First, consider each waiting list as its own entity as Shelah said. The residential waiting list is a list, but also the in-home supports list is a separate list. The waiting list for day programs now is a list, etcetera.

Second, as I mentioned please update this analysis annually not every three years which is currently what it says in the bill. And provide this information to the families annually. Not only one time as the bill states. I'll finish up.

Last, I going to echo what Shelah said, and what Leslie said considering the wording that the families can be more informed about the process including the PRAT Reviews and the Level of Need paperwork, that led to their children's priority status and any funding decisions made, now these decisions are made behind closed doors.

SENATOR GERRATANA (6TH): Thank you so much Marina. And thank you for your testimony.

MARINA DERMAN: Thank you very much.

SENATOR GERRATANA (6TH): Did you have, I think Representative Demicco has a question for you.

REP. DEMICCO (21ST): Thank you Madam Chair. Not to belabor this, I'm always curious in knowing personal stories. So your two children, did you have any difficulty getting information about your -- about your children's status and so forth? We've heard a lot of talk about you know that this information is supposed to be provided but it, you know it's not always provided in all cases. So you personally, did you have a similar experience to that?

MARINA DERMAN: I will tell you what it looks like. It looks like a black box. A black hole of information. So if you have a problem and you speak to your case manager about it and say, I would like to either ask for more funding, I'd like to get an immediate residential placement, I would like whatever it is. You make the request to your case manager and in our case the manager said I will write up that paperwork and then she said oh, well we have to write on a Thursday and they evaluate it on a Tuesday and if they don't evaluate it this Tuesday, they'll evaluate it the following Tuesday. So there's sort of a murky timeline upon which the PRAT can evaluate the suggestions that are made or the requests that are made. So some paperwork that you have not seen, goes from the case manager, which they have written it up and it goes directly to PRAT without going through you. And then PRAT does what it's doing behind closed doors and what comes out the other end is an answer. It's either yes or no.

REP. DEMICCO (21ST): Thank you.

MARINA DERMAN: Thank you very much.

SENATOR GERRATANA (6TH): And thank you. Next is Sue Bastein, following by Laura Lynn Louis, I believe is the name. We have about 43 more people to testify today it's 3:30 p.m. just be mindful of the three minute rule that we have. Thank you so much. Welcome Sue.

SUE BASTEIN: Okay, thank you legislatures. I'm totally in support of raised Bill No. 294. I am a parent of four adults who have intellectual disabilities. Three of them are served and one of them is still waiting for residential placement. Even though I have a background in Special-Ed, I'm a retired Special-Ed teacher, I served on the DD council. I've had a lot of experience. Going through the DDS maze is a very challenging situation for parents because we're not given the information that we need. For example, my son Patrick whom many legislatures are familiar with, he is still waiting for service. Patrick is 34, he's quadriplegic, blind, has epilepsy, intellectual disability, trach oxygen so on and so forth, he requires around the clock nursing because of his complex medical issues. And in October I lost the home care nursing that I had and replacement couldn't be found. So there was an emergency at that point because at that point I was in charge of 150 hours a week of home care nursing. So I requested that DDS make him an emergency for residential placement and this had to go to the PRAT Team, which is what I would like to talk a little bit about. I totally agree with that Marina said.

His information -- his caseworker agreed that this needed to go to the PRAT Team and the supervisor agreed, it went to the PRAT Team, however, I never saw the information that was sent to the PRAT Team, I was not allowed to be at the PRAT Team Meeting. The caseworker who knows my son quite well, was not at the PRAT Team Meeting, and all we got afterwards was no, he can't be made an emergency. And well one aspect of this was that he was considered an emergency enough for hospital for special care to admit him into their respiratory stepdown unit but not by DDS, but I don't know why because I wasn't allowed to be at the meeting and I never got any paperwork afterward telling me why he was denied. I assume it's from lack of funding, but I was never told this.

And this is what parents are going through. So even though I consider myself to have a good background in this I, really couldn't even follow the train of what was going on. Now imagine if schools ran this way and had PPT meetings where you don't allow the student if they're able, or their families who represent them to be part of the process. They can't attend the meetings, they can't participate, they don't get any minutes afterwards, that's what this is like. And it makes no sense whatsoever.

SENATOR GERRATANA (6TH): May I ask have you asked for that information and been told no, you can't have it?

SUE BASTIEN: I was, well first of all I was trying to even find out if it was a yes or a no. And eventually the caseworker he, well -- at first the caseworker said well you'll probably find out before I even find out. And I said well how, well --

SENATOR GERRATANA (6TH): Who, who do you find out from, if you don't find out from the caseworker?

SUE BASTIEN: That the information would be sent to me, but it never was because that's not how it's done.

SENATOR GERRATANA (6TH): So it comes in the -- it comes in the mail and you didn't get anything. So the caseworker is not --

SUE BASTIEN: But that's not how it's done. The caseworker made an error. That's not how PRAT even does it.

SENATOR GERRATANA (6TH): Okay.

SUE BASTIEN: So eventually the PRAT, I believe that the caseworker went to the supervisor and eventually found out what the situation even was.

SENATOR GERRATANA (6TH): I see, yeah. Earlier today, he commissioner --

SUE BASTIEN: It's very confusing because we --

SENATOR GERRATANA (6TH): Earlier today the commissioner had testified and admitted that you know there probably needs to be a little more training or some fine tuning with how that kind of communication is related to the individual or the families.

SUE BASTIEN: Well the fact is that according to the way PRAT actually works, the family doesn't get the information afterward. So it -- these things really need to be addressed in writing so that parents are given the information that they need. I believe that parents should also be allowed to attend the PRAT meetings and to participate in the PRAT meetings.

SENATOR GERRATANA (6TH): Well thank you so much for answering my questions and for giving your testimony to me today. Certainly do appreciate it. Are there any other questions? Representative, oh -- she's all set, okay. Well thank you so much.

SUE BASTIEN: Thank you.

SENATOR GERRATANA (6TH): Next is Laura Lynn Lewis following by Ben Shaiken.

LAURA LYNN LEWIS: Good afternoon, all members of the Public Health Committee.

SENATOR GERRATANA (6TH): Good afternoon.

LAURA LYNN LEWIS: I speak to you today as a parent whose son is a client and consumer of the Department of Developmental Services and who is one of the approximately two thousand individuals on the residential waiting. Had it not been for a medical emergency, a cancer diagnosis, my son would not be living an independent life with supports at this time. Many of you simply cannot grasp the lives that DDS families are living and yet the lives of the intellectually and developmentally disabled are being determined by the decisions made by the Connecticut legislature.

I have testified for three years in matters pertaining to the residential waiting list and it is the families who come before you to testify that are the most qualified to educate you on their needs. I'm here today testifying in favor of Senate Bill No. 294, but request the following amendments be considered, the DDS Commissioner should be required to report annually to the legislature on the waiting list numbers instead of the three years that is stated in this bill. The waiting list should not be confined to those individuals who are considered urgent but instead include every client in need of services. Separate lists should continue to be kept for various services that is the residential and day services. And I request that you include that DDS conduct a census and an analysis of the residential waiting list.

Little information is known about the waiting list, great inaccuracies exists and the legislature cannot plan to appropriate monies for the waiting list until accurate information is furnished. Two years ago when monies were appropriated to fund approximately 100 clients, DDS employees had to speak with families to understand stand their needs. The information gathered as a result of an analysis will allow for a plan to be created for each client.

Members of the Public Health Committee, passing this bill with these amendments is a necessary first step in righting the long, neglectful practice in this state regarding the civil rights of the intellectually and developmentally disabled. Even within the current budget constraints you can demonstrates to families that you are no longer willing to ignore the needs of individuals with IDD, that is a legacy you want to claim.

SENATOR GERRATANA (6TH): Thank you so much for your testimony today.

LAURA LYNN LEWIS: Thank you.

SENATOR GERRATANA (6TH): Next is Ben Shaiken following by Walter Glomb. Hello, good afternoon.

BEN SHAIKEN: Hello, good afternoon members of the Public Health Committee. My name is Ben Shaiken, I'm a public policy specialist at Connecticut Community Nonprofit Alliance, we represent more than 550 community nonprofits in associations across the state and we're the largest advocacy organization representing community nonprofits in Connecticut. Together our members serve more than half a million Connecticut residents each including large number of folks who receive services from DDS.

I'm here to testify today in support of Senate Bill No. 294, and I want to thank you all for raising this concept in this bill this year. I want to talk briefly about the portion of this bill that deals with the plan to close Southbury Training School and the Regional Centers. And the language has been changed around a little bit and so I've submitted electronic testimony, it may have squeaked after the deadline so if it's not up, it will be.

You know, very, very briefly to take from that testimony I just wanted to highlight that with proper supports everyone with intellectual developmental disabilities can flourish in the community. Over the last several decades community providers have been moving folks out of institutions and that's what Southbury and the Regional Centers are, and they you know were living formerly segregated lives and are now fully integrated in their communities.

I wanted to make on sort of specific regulatory point, which is that Connecticut maintaining institutions runs counter to the intent of federal regulation and law. Both the Americans with Disabilities Act as upheld in the Supreme Court Case Olmstead GLC as well as the Spirit of the Home and Community based services role that will go into effect in just about two years -- three years excuse me. Really mandate that people live fully integrated lives in the community and that's something that's a change that will happen nationwide and Connecticut should be on the forefront of that.

I'll also make the quick point that both this specific plan as well as alleviating the waiting list which there are several bills in front other committees and this committee about, is only going to work if providers are paid adequate rates. It's been a decade since there's been an increase to rates. It's been several decades of chronic underfunding, and it's going to be very difficult for a significant amount of new services to be offered at the current rates and so I wanted to bring your attention to that.

So the other piece of this bill that I wanted to talk about, which isn't in my written testimony actually but just listening to the testimony that's happened, which is stakeholder involvement throughout the process of closing these facilities about the waiting list, all of the stakeholders in the system need to be involved. And you've heard a lot from parents today, providers and families are intertwined, and along with DDS and you with the committee cognizance, the individual receiving services, all of us need to work together to make the system work and it's not going to work if we don't all work together. Thank you very much.

SENATOR GERRATANA (6TH): Thank you. Perfect testimony. We appreciate it and congratulations on the merger or collaboration whatever.

BEN SHAIKEN: Thank you we're excited.

SENATOR GERRATANA (6TH): I think that's great. Thank you. Representative Srinivasan has a question.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Good afternoon and thank you for your testimony today.

BEN SHAIKEN: Thank you.

REP. SRINIVASAN (31ST): You talked about Southbury briefly in your testimony and just the back part of the testimony, I too am in strong very. Very, very strong favor of closing Southbury, and obviously the state has to do what needs to be done, but I recently came across -- I met, had the opportunity to meet three families who is not your nephew or the child is in Southbury, and they told me, three separate families, that the conditions, the health conditions of the children/child/nephew is so severe that there is just no way, absolutely no way they could go into a residential place in the community, and I was a little bit -- I was taken aback but there was nothing that could be done and the intensity of the treatment that these people needed in Southbury. So I was just wondering if we come across -- obviously it would just be a handful of people that we cannot integrate into the, into a home setting. Any thoughts of what we could do with those small numbers of people. Obviously we have to take care of them. That is our moral obligation.

BEN SHAIKEN: absolutely and thank you for your question Representative. So I'll make a few quick points on that. And the first one is, that developing a plan to move us along towards the direction of inclusion across the state for people with intellectual developmental disabilities is not easy, if it was we would have done it a long time ago. And so there's not going to be an easy answer to a lot of these questions with specific individuals like the folks that you met. I will say though that you know for decades, I mean 30 years Connecticut has been closing institutions, community providers have been moving people with advanced and severe care needs and disabilities from institutions in the community and done it with huge success. Even folks at an advanced age, which is something that a lot of people who live at Southbury Training school have now. They haven't accepted admission in a very long time. And there's is example after example of people who nobody thought would be able to be successful in the community, being moved into a community setting you know in a planful way. In a way that was able to meet their needs and then flourishing for the rest of their lives and I could find 10 examples from my members of people you know who had that success. So I think it's not going to be an easy answer to that question. I think it's something that's an example of why we need to make sure that all of the stake-holders including families and guardians of the folks that are living at Southbury, is around the table as we make this plan.

REP. SRINIVASAN (31ST): Thank you very much.

BEN SHAIKEN: Thank you sir.

REP. SRINIVASAN (31ST): Thank you Madam Chair.

SENATOR GERRATANA (6TH): And thank you very much. Thanks for coming. Walter Glomb is next. Followed by Tom Fiorentino.

WALTER GLOMB:

SENATOR GERRATANA (6TH): Welcome Walter.

WALTER GLOMB: Thank you. Again, my name is Walter Glomb I'm a resident of Vernon. I'm a parent of an adult who has Downs Syndrome and currently lives with me. And naturally I'm concerned about the future provision of residential supports for my son and others. For, when the time comes and I'm no longer here. You have my written testimony and I'll be very brief. I want to be begin by just echoing, the comments by Leslie and Shelah. I endorse all the changes that they've recommended for this bill and I won't spend time on those except for maybe one.

I want to -- I do want to re-emphasize this issue of the PRAT, the Program Resource Allocation Team, being a, in effect the star chamber. They are secret proceedings, families are not given records of those proceedings. Families have asked and they have been denied, make no mistake. And we would appreciate you adding language to the bill that would require DDS to provide any and all documents that are used by the PRAT to deny services, okay? I think there is an element of fairness there but there is also an appeal issue. Because these are Medicaid services and families are guaranteed due process through DSS if it's a decision they don't agree with, but really how can they appeal if the record is denied to them.

So both Leslie and Shelah, mentioned that and I just wanted to echo it. Otherwise I would thank you for raising the bill. It's the kind of thing we need you know with a few changes. I think this will go a long way to helping families better manage their relationship with DDS and plan services for their children. Thank you very much.

SENATOR GERRATANA (6TH): Thank you so much Walter, we appreciate your continued advocacy in coming before our committee. Next is Tom Fioren -- Fiorentino, sorry Tom. I know who you are. Glad to have you here with us again.

TOM FIORENTINO: Thank you, I was here earlier this morning watching and I want to think everyone particularly the, the two co-chairs and Representative Demicco, who had a series of good questions the kind of questions that I, I was hoping would be asked of the commissioner and other people that appeared before you.

I'm not going to -- I did submit my written testimony although apparently I did it the first time anonymously. I resubmitted it with my name on it. I'm not going to reiterate what I said there. I do support a lot of what's been said. I support this bill on transparency at the department but as acknowledged it's an imperfect bill. Some of the imperfections were pointed out by the commissioner. Some of the definitions used are confusing. To change what was an emergency to urgent doesn't make a lot of sense to me. The three year update is -- I don't think anybody really thanks that, that makes any sense.

The folks who have said that the records maintained by the department, the ones that they do have, are imperfect because they have not been updated in a meaningful way, I agree with that. My wife and I have never been asked by our case manager what's going on residentially? What do you need? What do you think you're going to need? That ought to be asked, it ought to be documented so that the department can plan.

The questions that were asked about Southbury Training School, and what do you do with the folks who are unable to be moved to the community? I would point out to you all that there are 15 states in the District of Columbia with no institutions at all. They take care of, and manage those situations that the Representative was talking about without institutions. At Southbury, it's a very small number, as identified by staff. It's about 20 people who they've determined cannot go into the community. That doesn't mean an institution that cost 365,000 per person per year, should be maintained, but an alternative to the institution and I'm -- I'm assuming an alternative to care in the community although I understand that for every single person at Southbury Training School, there is a coronary person with similar needs, medical and otherwise being taken care of in the community. It's a matter of whether the resources are going to be there to support that.

Finally, I talk about the PRAT that Walt mentioned at the end and Laura Lynn and other people, Sue -- has her ow experience. As we understand it, and I'm not saying that what the commissioner testified to is in any inaccurate, and we know what we know. I'm telling you though that the parents that we talk to as advocates say, they don't know what's being presented on their behalf. They don't know what discussions are being held a about their child. They know that they'll get a yes or a no answer. That's hard to live with when in, at least in the view of the family, it can be a life or death matter, and you get a thumbs up or a thumbs down with a lot of -- without any explanation.

I think that can be changed. I think the HIPAA matter that people are talking about is -- the HIPAA matter is that other cases are discussed at the same meeting. So I might have a right to my son's records, but I don't have a right to Representative Demicco child's records.

SENATOR GERRATANA (6TH): Right.

TOM FIORENTINO: We still think there are ways that you can produce a meaningful report on what happened without violating that.

SENATOR GERRATANA (6TH): I see. Well thank you Tom. Thank you for your testimony.

TOM FIORENTINO: As always.

SENATOR GERRATANA (6TH): We have a -- wait a minute, Representative Demicco has a question.

REP. DEMICCO (21ST): Yes, I just Tom you're a very thoughtful guy, and you have a lot of good ideas just since three minutes ran out I just want to give you an opportunity, is there anything else that you would like to add as far as what we need to do with this bill?

TOM FIORENTINO: I think people appreciate it being brought up, but people need to sit down and think in a meaningful way, are we improving this system with some of the things that are in here. The three year thing is not an improvement. The redefinition of a waiting list to only include urgent or what is now known as emergency, I think everybody would concede. Even the department I think would agree, that doesn't give you an accurate picture, and we're not sure why it's in there. I, I think it's people are trying to do the best they could under a short timeline, and so there are things in there that don't make any, any sense. I think that the idea of a unified list for the residential waiting list, I understand. But it can't be including day services, respite services and everything else. The department ought to have a requirement -- there should be a requirement that they maintain separate lists. My feeling is, it might not look good but unless you know exactly where you are it's very hard to know how far you've got to go and where you're going.

So, thank you Representative for the opportunity to expand a bit.

SENATOR GERRATANA (6TH): Thank you. Thank you again. Next we have Denise King, to be following by John Brady. Hi Denise welcome back.

DENISE KING: Hi, thank you. Thank you to the Public Health Committee for hearing us on Senate Bill No. 294. My name is Denise King, I'm a parent and a grandparent and have been up here in Hartford testifying for three years now. My husband and I have are the custodial grandparents of Matthew and wonderful 25 year old young man, wit intellectual and developmental disabilities. He has been waiting and continues to wait for residential placement in a home with his peers. As pointed out to other legislators the caregivers will soon need caregivers. We've been meeting up here with many legislators, in a bipartisan effort to formulate a foundation for our work in the future. Bill No. 294 is absolutely first and foremost an effort to look at the wait list. I would like to suggest several amendments to this bill that would serve as a solid foundation for moving forward.

For three years we have been here in Hartford talking about the infamous wait list. Section 1, Part 3 of this bill talks about this list or these lists. In order for the wait list to be a viable tool in beginning to formulate a plan to help our loved ones, the numbers have to be validated. The wait list as it stands now is inaccurate and the numbers, old. There are people on the list who do not want residential placements, and there are people on the list who are designated Priority 2 or 3, who want/need residential placements, now.

There is confusion as to who should be on the wait list, and what the wait list is for. In order for any future work to be accomplished we need a census taken to establish a baseline. How can anything be appropriated and a plan made, if you don't know who or how many are being planned for. We heard Commissioner Massey this morning -- Commissioner Murray this morning talk about a group that she has or a committee that she has that is working on this wait list. I think at the commissioner is misinformed. I, I gather that he has not been to any of these meetings or committee meetings. But we do have a parent that is on that committee. And really the only thing that they are working on is some of the nomenclature. They are not working on the numbers for the wait list.

Former Commissioner Massey, told us several years ago, as we were up here testifying, that he knew who we were. He knew our case, and that we were not on the wait list, because our grandson receives 23 hours of home supports. A person should not be taken off the wait list or put on another list if they accept day services as a band-aid until residential placement occurs. This point has become very confusing with mixed messages given from DDS about this practice. And requiring DDS to update this list every three years will not maintain an accurate picture of the ID community. Thank you for hearing my testimony.

SENATOR GERRATANA (6TH): Thank you very much Denies, and thank you for your continued advocacy. We do appreciate it. I don't think there are any questions , so. We'll go back to our elected officials list. I see Senator Looney has arrived, so he can come up and testify. And then we have John Brady.

SENATOR LOONEY (11TH): Thank you Madam Chair. Good afternoon Senator Gerratana, Representative Ritter and distinguished members of the Public Health Committee, I'm Martin Looney, State Senator of the 11th District, representing New Haven, Hamden and North Haven. And I'm here to testify in regard to several bills on your agenda today. First Senate Bill No 289, AN ACT CONCERNING HEALTHCARE SERVICES. And House Bill No. 5455, AN ACT ESTABLISHING A TASKFORCE ON PATIENTS MEDICAL RECORDS. House Bill No. 5451, AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR VARIOUS REVISIONS TO THE OFFICE OF HEALTHCARE ACCESS STATUTES. And Senate Bill No.298, AN ACT CONCERNING TELEHEALTH SERVICES FOR Medicaid RECIPIENTS.

So, first of all there are several provisions in Senate Bill No. 289 that are of grave concern to me in that they would rollback some of the important strides towards transparency made last year in Senate Bill No. 811, that became Public Act 15-146. I understand that this language was requested by the Connecticut Hospital Association and that the committee agreed to give these concepts a hearing, but I believe that -- and this hearing will prove to be useful. I'm disappointed however in the CHA proposals. I'd been assured by their representatives that they would request only technical fixes and had no plans to attempt to rollback any of the provisions of Senate Bill No. 811. Unfortunately, the hospital associations requested language does exactly that in some important respects.

Beginning January 1st of 2017, Senate Bill No.811 bans facility fees for a limited number of services, specifically evaluation and management services. For all other facility fees, it requires that hospital billing statements clearly identify all facility fees charged at hospital owned physician offices that are not on the hospital campus. Section 3 of this bill, would effectively eliminate this important patient notice and transparency requirement by only requiring notice of facility fees for evaluation, and management services. This would eviscerate the legislation and it doesn't make a lot of sense, that by the time that reporting would be required those fees will no longer be charged. Hospitals would then be free to charge for facility fees for all other outpatient community services -- community based services with no billing notice and this directly undermines the input and the intent of patient notice requirement which is to increase transparency and patient awareness regarding facility fees and hospital billing practices.

Also Section 1 of Senate Bill No. 289, would circumvent the price disclosure requirements that hospitals are required to give patients under Senate Bill No. 811 when scheduling a non-emergency procedure. Senate Bill No. 811, requires hospitals to notify patients upon request and within three days of scheduling a non-emergency procedure of the charge or allowed amount for the procedure and comparative Medicare rate for such procedure and certain care quality information. Price transparency is perhaps the single, most important thing we can do to promote competition and enable consumers to make smart value based decisions about where they will go for care. This language was modeled after legislation previously adopted in Massachusetts and other states. No other industry would expect to be able to bill a customer for service costing thousands or even tens of thousands of dollars without first providing an estimate. If they can do this in other states and it's good for almost every other industry, hospitals can do it here in Connecticut. It's absurd to think that posting this information on hospital websites or an internet portal as Section 1 of the bill proposes, is sufficient. If a hospital can mail a bill to a patient, it can mail a notice. Senate Bill No. 811 even allows for electronic delivery, however it must be delivered to the patient and not simply posted passively on a website where a consumer must search to find it. Section 1 also extends the already generous effective date for the requirement that hospitals inform patients regarding cost and quality data.

In addition, the language in Section 4, that would exclude medical foundations from the notice of affiliation requirements is completely inappropriate. Patients are often unaware of the business relationships or affiliations between providers. For example, hospitals now employ hundreds of community based physicians through their affiliated medical foundations. Who then refer patients to each other and to their affiliated hospital. Providing increased notice and transparency regarding these affiliations as well as informing patients that they have a choice of provider is critical. We know that services at hospital affiliated physicians often cost more due to both facility fees and the increased reimbursement at large integrated health systems leverage. Patients cannot seek out value based care if they are unaware of these affiliations, and don't know they have a choice. Excluding medical foundations would eviscerate the effectiveness of this section of Senate Bill No. 811. The medical foundations were specifically and intentionally included in the notice requirement. I'm also concerned that Section 8 effective date is changed from July 2016 to January 2018, and in the final section of the bill it's also unclear why a hospital would want to allow an unlicensed or uncertified person to connect and disconnect oxygen supplies as this bill would do. Some of the other language changes in other sections would also seem unnecessary and appear to make the legislation less clear.

Although I support the provision in Section 6, that ensures that the notice of changes in the corporate structure of group practices are reported when the acquiring entity is an insurer of other business, I prefer to expand the definition of captive professional entity to include these business organizations. I would encourage you not to pass Senate Bill No. 289, but rather to add the few suggestions that are in fact, technical to the bill on hospital physicians that I hope will be heard next week.

On Senate Bill No. 5455, I strongly support this bill, AN ACT ESTABLISHING A TASK FORCE ON PATIENTS MEDICAL RECORDS. I have long been in favor of making patient records easier for patients to access and believe this task force should review the new federal requirements on patient's access to their records, which would be a good place to start.

Also interested in the subject matter of Senate Bill No. 5451, AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR VARIOUS REVISIONS TO THE OFFICE OF HEALTHCARE ACCESS STATUTES. I look forward to working with you on the Certificate of Need process. I'm concerned that the bill moves forward effective dates regarding notification of changes in the corporate structure of group practices.

Finally, a few words on Telemedicine. I would like to offer support of Senate Bill No. 298, AN ACT CONCERNING TELEHEALTH SERVICES FOR Medicaid RECIPIENTS. Last year the General Assembly passed and the governor signed Public Act 15-88, which require private and group health insurers to cover healthcare services provided by telehealth providers. The law was written to ensure that the provider standards of practices and care are upheld and safeguarding that quality is never compromised during a telehealth encounter. Telehealth is not a substitute for in-person care, but rather a support to it and a supplement to it. That's why I am opposed to Senate Bill No. 291, which would weaken the standards of practice by eliminating the requirement that healthcare providers have access to the patient's medical record and medical history. Allowing one or the other would weaken this strong provision.

This year, with the passage of Senate Bill No. 298, we would make quality affordable healthcare, more accessible to the Medicaid population. These are people who often have difficulty accessing the healthcare system currently and telehealth would provide more access and encourage your support.

Thank you for your consideration of all of this important legislation and for all of the valuable work that this committee does year in and year out. Thank you very much, Madam Chair and Mr. Chair.

SENATOR GERRATANA (6TH): Thank you Senator Looney, thank you for your testimony today. Does anyone have any questions? Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Senator Looney for being here tis afternoon and for your in depth discussion on these various bills that you brought about, we appreciate that very much.

On Senate Bill No. 291, AN ACT CONCERNING FEDERAL HEALTH PROVIDERS. The way it's written now would weaken and I gather that you are in opposition of any weakness the system of providing medical help through telehealth services?

SENATOR LOONEY (11TH): Yes, I believe that Senate Bill No. 289 -- 298, is one that will enhance the quality of telehealth services. My concern to 291 is that it would to some extent reduce the amount of information available to the physician. In some cases, regarding their patient and that might result in the beset decision making practice for that physician, perhaps through no fault of his or her own because he wouldn't have the whole record before him or her.

REP. SRINIVASAN (31ST): Senator then if those medical records are not available as what was initially intended and then in that situation you feel that the telehealth services should not be rendered?

SENATOR LOONEY (11TH): Well I think it's something that we should at least look at in terms of trying to provide that every way of ensuring that they are available should be pursued because otherwise I think there is a potential danger of inadequate information perhaps leading to a misdiagnosis when the full record is not there.

REP. SRINIVASAN (31ST): thank you very much senator, and also, will you comment on the liability on the part of the provider when the records are not adequate, and how would that impact the medical liability?

SENATOR LOONEY (11TH): I think that another excellent question, and that does raise questions about whether that liability would be on that physician for making the -- going forward with a decision on treatment that might be contraindicated by something in the record that he doesn't have or whether that liability should fall elsewhere for the unavailability of that record to him. So I think that's an issued certainly that also would need to be clarified in considering this whole subject.

REP. SRINIVASAN (31ST): Thank you very much senator. Thank you Mr. Chair -- Madam Chair.

SENATOR GERRATANA (6TH): Thank you so much, are there any questions. If not, thank you Senator Looney for coming today. We'll go back to our rotation, we have John Brady and then following by Senator Fasano.

JOHN BRADY: Good afternoon Senator Gerratana, Representative Ritter.

SENATOR GERRATANA (6TH): Good afternoon.

JOHN BRADY: And members of the committee, my name is John Brady, I am a registered nurse and the Executive Vice President of AFT Connecticut a union of over 30,000 people including 7000 in healthcare and acute care hospitals and school nurses. I'd like to speak to you briefly today about four bills. The first being 5460, AN ACT CONCERNING ADMINDND OF GLUCAGON IN SCHOOLS. We oppose this bill because we feel it would require non-licensed personnel to administrator glucagon if assigned regardless if they felt comfortable in performing this function. The fact that they could not opt out is a requirement that is unacceptable to us, and we urge you to reject this bill.

On 5421, AN ACT CONCERNING THE DEPARTMENT OF PUBICL HEALTH'S RECOMMENDATIONS FOR VARIOUS REVISIONS TO THE OFFICE HEALTHCARE ACCESS STATUTES. This act concerns several changes DPH is recommending for OHCA. We support these changes. As we saw in the Certificate of Need process that Hartford Healthcare and Windham Hospital, changes are needed. One of OHCA's obligations is to determine if Certificate of Need is indeed needed before changes take place. Hartford Healthcare mislead OHCA by calling the Windham changes a reclassification. The proposed changes in this bill would give OHCA the much needed resources it needs to do it's due diligence to protect the public access to quality affordable healthcare by requiring the applicant to contribute to an establishment of escrow account to cover the cost related to analysis, investigation and review including retention of outside experts in the field so that we would urge you to support this bill.

On Senate Bill No. 291, AN ACT CONCERNING RECOMMENDATIONS OF A SCHOOL NURSE ADVISORY COUNCIL. Advisory council is recommended that every school nurse in Connecticut complete an orientation program within one day of the year of hire. Although this may seem like something that is standard practice, the truth is, that it is not. Nursing has become highly specialized and school nursing presents unique challenges that a well qualified nurse working in a hospital or clinic may not be prepared to handle. Such an orientation is in the best interest of our students and the nurse providing the care, so please support this bill.

And the last one is Senate Bill No. 299, AN ACT CONCERNING THE ADOPTION TO ESTABLISH MINIMUM STANDARDS FOR SCHOOL BASED HEALTH CENTERS. School based health centers provide needed care to students in our state. We support such centers. However, currently there is little to define or regulate what constitutes a school based health center, and what care it can provide. This bill requires the Department of Public Health to adopt regulations establishing minimum standards for the centers and we would urge you to support that.

Thank you for your time, and I will try to answer any questions you might have.

SENATOR GERRATANA (6TH): And thank you for your testimony. I think only Representative Srinivasan has a question.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you very much for your testimony. On House Bill No. 5460, regarding the administration of glucagon in school.

JOHN BRADY: Yes.

REP. SRINIVASAN (31ST): How would the administration of glucagon be different than the administration of epinephrine for allergic reactions in school?

JOHN BRADY: I think -- I think the problem, there is as we saw in the great demonstrations this morning, there is -- it doesn't come in as a copycat. It is a little more complicated. My concern is this, I think the intent of the bill is good, to have people in the school who can administrator glucagon to a student in an emergency. I don't want people to not volunteer if they are forced, once they learn the process, then they are forced under law to do it. I can see a situation where someone would back off from learning the process if they felt they were compelled to do it after that. That is my concern on that.

REP. SRINIVASAN (31ST): Maybe I'm not getting your train of thought. So you're saying somebody would volunteer but if you forced them to do that, they might not be ready to do that?

JOHN BRADY: Because I, I -- in situations like this, you have to go through the training process. And sometimes you don't know what you're getting into until you go through the training process. And I don't think we want to discourage people from learning about it, and potentially becoming an administrator of glucagon in the schools. And if, if I -- I can see a situation where some people would say, oh I'm not taking that training because I don't want to be in a situation where I've learned how technically, to do it, but I don't feel comfortable doing it, and I, I don't want to. I want to defer to somebody else. And then yet, be forced to do it or be subject to discipline or, or breaking the law.

REP. SRINIVASAN (31ST): Thank you. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. And again, thank you for coming today and giving your testimony. Oh, wait a minute, Representative McCarty has a question.

REP. McCARTY (38TH): Thank you Madam Chair. And just so I can be clear on your response to Representative Srinivasan, so you would not be opposed to other personnel administering it if they decided and they have taken the training, and they were willing to administrator it, is that correct?

JOHN BRADY: I think if people have the proper training and it's yearly as this is indicated, and no I would not be opposed to them administering it. But, my concern would be that you know, they would feel forced to once they learned.

REP. McCARTY (38TH): Okay, I appreciate that response, thank you And thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you very much. Thank you for coming.

JOHN BRADY: You're welcome thank you.

SENATOR GERRATANA (6TH): Senator Fasano, following by Bob Namnon.

SENATOR FASANO (34TH): Thank you senator. Senator Gerratana, Representative Ritter, Representative Srinivasan. First, I know you guys had a long day, so I'm going to abbreviate my testimony, and I know you'll appreciate that. But this is Senate Bill No. 294, all of you know the problems that DDS families are having with respect to not having enough information to make decisions. And I think the way you have to look at this bill is say if I had a child that I did not know what was going to happen to that child two years from now, three years from now upon my death. That would remark you as being totally unfair. And if you could not plan because you did not have the tools and you did not understand the rules for which the world works around you, then therefore you have to be scared for your child because you have no idea what that's like. So I think what this bill seeks to do is to try to sort out some of the issues that their faced with so that families know when they're on a waiting list, know when they're going to be removed from the waiting list. And I've got to tell you, I think the DDS Families First and the Arc, are passionate in their commitment to the cause and I know that this committee has welcomed their concerns with open arms. And I want to thank you for that. Because you are the only avenue to bring sanity to their world which sometimes they believe sanity doesn't exist.

So one thing in this bill, I think that all of us agree should not be in this bill, and I would ask you to remove is the Southbury Training School issue. I think you heard some people talk about, it's something that we all acted upon last time, so that should be removed. But I think if you look at the other parts of this bill and there was a meeting this morning between Arc and DDS Families where there is some language that I would like to offer to this committee. I thought I'd have it today, but one of the drafters went home sick. Hopefully I'll have it tomorrow or the next day to send to the committee, which deals with some issues to make this bill a better bill and I'll get that to all of you that I think both the Arc and DDS Families want to have.

But the bottom line is, we need to give some predictability, some certainty to the lives of these families and to Arc who helps through this process and currently I would suggest, it simply doesn't exist.

So I want to thank you for your time. These are very tough issues and I know you give it the most consideration anybody could give to this issue, and thank you very much.

SENATOR GERRATANA (6TH): Thank you senator. Thank you for your testimony today, and speaking to us about that. And you know, our committee has been working on this issue and dealing with it for many, many, many years but I think we're always glad to have that conversation if you will and certainly to listen to the people who come up here. We've had great testimony today. Take a look at commissioner's testimony. She was very, very thorough and at least sharing with us a lot of information about what the process is, and she has indicated that she is happy you know, happy to work with us on dealing or writing any language that is necessary.

The bottom line is, I think she and I think we all are aware of is the communication. And the communication with families and I think it's hard for us all to recognize that these are challenges that families have every single hour, every single minute of the day. And that, anything that is going to help them and support them is going to make a better quality-of-life for them and of course, their loved ones. So, I think that's the bottom line here. And we certainly are up to our job so to speak. And we thank you for your support in that.

SENATOR FASANO (34TH): Thank you. Madam Chair, I did not hear the commissioner's testimony but I will look up the commissioner's testimony.

SENATOR GERRATANA (6TH): Take a look at it, yes.

SENATOR FASANO (34TH): And one of the things though I think that still does strike me is that is when somebody is removed from the waiting list, they have no knowledge that their child was removed from the waiting list. And I think that simply could be handled as our legislation talked about, that before somebody is removed, for instance, if someone is getting assistance and has a problem they give them more assistance. Their names sometimes get removed from the waiting list, but the family never knows that. And yes, it's a communication concept.

SENATOR GERRATANA (6TH): Yes, yeah. I guess it's with caseworkers and all that interaction, the commissioner recognized that you know, there's more to be done you know in that area. But it's a little confusing too because I was reading through all the testimony and you know and you or somebody in your staff should go through it because there are many kinds of wait lists, if you will.

SENATOR FASANO (34TH): Yes there are.

SENATOR GERRATANA (6TH): And of course a lot of that depends on resources that the department will have, and I don't think there is anyone in this room that isn't aware of the fiscal situation in at the state, and certainly we have worked very hard to ensure that you know this department is funded correctly. But a lot of those resources you know have basically become scarcer and of course you know that has engendered a number of waiting lists and the whole concept of a waiting list has been debated. You know I'm giving you my input from you know 15 years being up here. This is not a new debate, and hearing of course appropriately what advocates have to say as well as you know, whomever administration, if you will. It certainly has been a challenge. But you know I think sometimes we shouldn't use wait lists, and we should look at least from my perspective, this is a healthcare issue, and this is looking at the individual and what the individual needs. And how we get to that place I think is something that we all want to work toward.

So wait lists notwithstanding, I think rather that approach is a healthcare if you will, approach. And that's the way I look at it. And that's the way we should all look at it.

SENATOR FASANO (34TH): Madam Chair, may I just add one more thing. One of the pieces of language that we'll be sending to the commissioner -- to the committee was an idea put through by Arc and talked about with the families, which really, but there isn't a baseline of understanding where we are and what we can expect, as a legislature for the future. And until we have a baseline of how many kids are getting at the high school system that will be turned over to this system, with some knowledge of how we can do it, I don't think that as legislators we're ever going to get our arms around this. So we have some legislation that we'll be proposing as an addition to this to talk about.

And once again, I thank you for your time and your commitment to this issue.

SENATOR GERRATANA (6TH): Thank you, don't go away I think Representative Srinivasan and Representative McCarty have follow up questions for you.

SENATOR FASANO (34TH): Okay, thank you.

SENATOR GERRATANA (6TH): We'll start in that order.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Not so much a question but just a comment. Senator I want thank you for being here this afternoon, and all the advocacy that you do, on behalf of all the people of the State of Connecticut. We all appreciate that very much.

SENATOR FASANO (34TH): Thank you Representative.

REP. McCARTY (38TH): Thank you Madam Chair, and yes I would like to also recognize your work that you've done to bring this very important issue to all of our attention and to follow up with Senator Gerratana that this morning listening to the commissioner and really giving such detailed testimony about the waiting list and the categories I felt very hopeful that we would be able to work to find a solution to this issue.

I'm also -- my question really was that I'm happy that Arc is involved and trying to find this information for the baseline and do you have any idea when that information will be, become available to us?

SENATOR FASANO (34TH): Well, the proposed language may be -- Jennifer Maturowski who drafts this stuff just wasn't feeling well, she came in this morning and left, and I don't know when she'll be back, but I would suspect by the end of the week, we should have something I can give to you guys, and I'll send it to the Chairs or to the clerk who can pass it out.

REP. McCARTY (38TH): Again, thank you very much. Good to see you.

SENATOR FASANO (34TH): Thank you Representative.

REP. McCARTY (38TH): Thank you Madam Chair.

REP. RITTER (1ST): Senator you make sure Jen gets well, okay.

SENATOR FASANO (34TH): I, I know.

REP. RITTER (1ST): We know how important she is to all of us, so.

SENATOR FASANO (34TH): Thank you Representative Ritter.

SENATOR GERRATANA (6TH): She really is. Thank you Senator.

SENATOR FASANO (34TH): Thank you Chairs.

SENATOR GERRATANA (6TH): Okay. Next we have Bob Namnon on 5460 and then we move onto Senate Bill No. 91, Dr.Sandra Carbonari. I think Dr. Carbonari, are you still here? I, I don't think so. She testified earlier and I think she included a statement. So then we'll go to Dr. David Boisuneau. Do we have Bob? Bob Namnon? No, Bob isn't here. Okay, then Dr. David Boisuneau?

DR. DAVID BOISUNEAU: Here.

SENATOR GERRATANA (6TH): You're up.

DR. DAVID BOISUNEAU: Hi there, thank you Public Health Committee for hearing my testimony today.

SENATOR GERRATANA (6TH): Thank you.

DR. DAVID BOISUNEAU: It's been a long day I know. I'll be brief, I have two bills to discuss today. Senate Bill No. 291, AN ACT CONCERNING TELEHEALTH PROVIDERS ACCESS TO MEDICAL RECORDS. As well as No. 289, AN ACT CONCERNING THE HEALTHCARE SERVICES. My name is David Boisuneau. I'm a board certified ear/nose and throat doctor in Waterford, Connecticut. I represent over a thousand physicians in ear/nose and throat, dermatology, ophthalmology and urology in the state. As you know Senate Bill No. 291 was raised last year in this committee and subsequently has become state law effective just eight weeks ago. Testimony presented last year by our collective physician groups highlighted several concerns that we had with the original bill. Specifically with the need to establish clear guidelines moving forward with telemedicine in this state. Additionally we were concerned and remain concern at the standard of care for telemedicine is not given the same level or value of care as an in-person encounter. We must be mindful of the serious deficit also plaguing the state of Connecticut, budget deficit and how Connecticut cannot afford to lose revenue from outsourcing medical services through telemedicine, which could also be a byproduct if safeguards are not put into place.

That being said, Senate Bill No. 291 does stipulate some very thoughtful criteria. Specifically mandating realtime interactive two-way communication as well as access to or knowledge of the patient's medical history. As both provided by the patient and the patient's medical health record. This simple word 'and' helps to ensure that the remote provider is evaluating the patient in the most comprehensive manner possible within the limits of the technology and we believe should remain in the bill. We are concerned that changing this condition to 'or' which is what has been proposed, may thus allow the remote providers to ignore the health recorded potentially ignore the health recorded, and make the telehealth provider rely upon obtaining most or, if not all of the information directly from the patient.

It may not be possible to have a full health record in every case, and this change could permit a less rigorous medical evaluation. But again, the standard of care cannot be compared to an in-person encounter and the provider cannot be held accountable to this higher standard.

As currently worded, the law limits telehealth to those situations in which there is a readily available, shared health record, which will likely only be with larger health systems in fully integrated expensive EHRs or with a specialist looking for a second opinion on difficult diagnosis.

A fundamental component of our medical training beginning almost on day one of medical school is learning how to comprehensively evaluate and manage a patient by obtaining a direct medical history, from the patient and fully reviewing all available data. We are concerned that this bill may lower that standard to something less than you would expect from an in-patient -- in-person doctor/patient encounter.

The second bill, I'll just 289, the transparency bill was handled very nicely I thought by Senator Looney a few minutes ago. Transparency is something that we all agree with but I have to tell you it's very difficult practically as a physician to really understand the cost and to be able to explain that to a patient it's very difficult for us to understand it, and it's very difficult to explain it to the patient as well. Thank you.

SENATOR GERRATANA (6TH): And thank you so much for your testimony. Does anyone have any questions? Representative Srinivasan, followed by Representative McCarty.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you doctor for being here this afternoon and testifying very briefly one bill and of course more elaborately on the other. So going to the first one on raised Bill No. 291, that we just talked about. You know we are all concerned with telehealth medical services. Yes we understand technology and the advantages of doing that. Yes we get that but obviously along with that comes the concerns of whether we have information -- we have adequate information. And as you know and I know, in real life depending on the patient to get us all the information that is needed most of the times is not available. I mean you know -- and the patient has information about his or her own medical condition, but quite a few times it can be very limited, and so we do depend on those medical records of the patient's to make the appropriate diagnosis and obviously the treatment.

So, in your opinion if those medical records were not available, and then the telehealth provider had to depend only on his own history that he is taking and the patient's information, do you feel that would be compromising the care that the patient could receive?

DR. DAVID BOISUNEAU: That's a great question. I, I believe it would. You're trained very similarly I'm sure to the way I was trained and the face-to-face, direct patient encounter with all available data, gives the highest level of care you can possibly give to a patient. If I was the patient, I'd be very concerned if I was interfacing with a remote provider and that remote provider had very little knowledge of my background or my medical problems other than what I'm able to articulate to them, which as you know can be sometimes difficult when you're dealing with certain conditions and sick patients.

So, this is a paradigm shift. This is on something that is evolving, and this is the early part of this. So, this is -- now is when we have to codify things very carefully and be very rigid I think on how we define these encounters. I think it helps everybody especially the patient, number one.

REP. SRINIVASAN (31ST): Thank you, and I'd asked Senator Looney this question and I want to get your response on it as well. In terms of the provider, you know we talked about the compromised healthcare that the patient would receive with inadequate records. And then flipping it to the other side as far as the liability of the provider who provides such a service with not the complete information, holding him or her to the same standard of liability would also be unreasonable according to, in my opinion, and I want see what you thought about that.

DR. DAVID BOISUNEAU: Well I couldn't agree more. I would not want to as again, as a patient or I'm sorry, as provider render my medical opinion when I don't have the full information on the patient I don't -- again, it's a new, an evolving field. I'm not which providers would allow themselves that exposure even if it's theoretic at this point. I'm not even sure if there's been cases yet regarding this but I would be very concerned as a provider myself offering my services without being able to get a comprehensive you know review of data of the patient.

REP. SRINIVASAN (31ST): Thank you very much. Thank you Madam Chair.

DR. DAVID BOISUNEAU: Thank you very much.

SENATOR GERRATANA (6TH): Thank you. Representative McCarty, did you have a question? Hold on Dr. Boisuneau, there's one more question.

REP. McCARTY (38TH): No I just really wanted to welcome you being a constituent from Waterford and to thank you for your perspective and for your testimony on this important bill. Thank you very much.

DR. DR. DAVID BOISUNEAU: Thank you very much.

REP. McCARTY (38TH): Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Next we have Matthew Katz, following by Dr. Rebecca Hafner-Fogarty.

SENATOR GERRATANA (6TH): -- Zipnosis? Hi, Matt.

DR. DAVID BOISUNEAU: How are you? It sounds like a condition doesn't it? Senator Gerratana, Representative Ritter, and members of Public Health Committee on behalf of the physicians and physicians in training of the Connecticut State Medical Society and Connecticut Chapter of the American College of Physicians, thank you for the opportunity to testify today on Senate Bill No. 291 , AN ACT CONCERNING TELEHEALTH PROVIDERS ACCESS TO PATIENT RECORDS. This proposal is a prime example of when one word matters. When one change impacts an existing good bill. We have significant concern as Senator Looney pointed out previously and Dr. Boisuneau eloquently stated, how an impact such as this by changing the word 'and' to 'or' would dramatically change the intent, direction and desire of the medical community here in Connecticut. The need for the medical record is germane. It protects not only the patient but also the physician from a prospective of insuring the continuum of care and safeguarding standards of care in the state of Connecticut.

We have great concern with any change to legislation when it takes place eight weeks after the effective date of the existing legislation. We have nothing to determine or to evaluate the effectiveness of what was just passed by this General Assembly north do we believe dramatic change such as this is warranted given the fact that so many testified previously last year on the ill and worked hard on a compromise bill to ensure that patients had access. Those that didn't have access had opportunity to gain access but that medical providers, all providers physicians, APRNs and others were able to ensure that their patients were being treated fairly, appropriately and consistent with the standards of care.

So for that reason and knowing that the hour is already late, I just want to highlight our strong opposition to this bill and this change and the need to see during this transition process of medical care in Connecticut how what was passed last year, is effective or ineffective before we make any dramatic change such as this.

So thank you very much and I'm happy to take any questions.

SENATOR GERRATANA (6TH): Thank you. Thank you very much. Are there any questions? Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you for being here this afternoon with your testimony.

So as you said since we have just passed -- since the law that we passed has just become effective, so would you -- I, your suggestion to us, for us to consider is to nothing at this particular point, wait on this what you've already passed. See the impact and maybe come back at some later point in time to see what we have passed, what impact it has had before changing it so quickly?

DR. DAVID BOISUNEAU: Absolutely Representative, as an organization that worked hard with tis committee and the General Assembly to craft something that made sense from a standards of care prospective, patient care prospective, and to weed out some systems companies and approaches that were not good for patient care, we think it's important to evaluate and have time to evaluate the effectiveness of what was passed in legislation last year, before we make any changes. I know this is only a one word change but it is a dramatic change, the intent and the breath of what this means for patient care in Connecticut.

REP. SRINIVASAN (31ST): Thank you very much, you said it very well, it's a one word change but it's a very, very major impact and what would be, which physician would want to take care of a patient where the medical records are not available. It's an integral part of what we need to take care of the patient because yes, we do rely on the patient and the patient's history significantly. But we need to collaborate that with documented evidence on that patient as well. So to have that information available and for the provider to access as much as he or she wants, is essentially very, very critical in management, A number 1. Number 2, when you are managing the patient by telemedicine, where there's a good chance that you don't know the patient you know it's not your patient that you've known for the last five years or ten years, where you practically have the history in your head about that patient. And this is somebody that you probably have not seen before at all, and you're compromising the care of that patient if you don't have the records.

DR. DAVID BOISUNEAU: Absolutely doctor -- or, Representative sorry. The I, I think it is critical and important to ensure access to that information as we get our hands around what is health information technology. It's purported to be and should be a way to guarantee greater access to info and provide better care delivery.

The problem is in some of these telemedicine based systems you end up actually making it worse. You make the problem you're trying to solve worse by limiting showing off, or protecting or insulating that information. What we worked on last year was to ensure that if someone was providing this level of care, this type of care delivery, they have all the necessary access points to information possible. They have the information that, that physician sitting in the same room would have in order to make an informed treatment decision for that patient that was best for that patient at that given time. Not having that information, not having access to that information is unfortunately a situation we don't want to have happen in Connecticut and it is a symptom of a larger problem in this country when it comes to wanting something really quick and easy, but not thinking about the consequences until after.

We want to -- we thought last year about the consequences now and later, and that's why the bill is the way it was passed last year to ensure and protect patient care delivery in the state and we would like t make sure we continue to do so.

REP. SRINIVASAN (31ST): Thank you very much. Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. I think that's it. Thank you for testifying.

DR. DAVID BOISUNEAU: Thank you Madam Chair.

SENATOR GERRATANA (6TH): Next is Dr. Rebecca Hafner-Fogarty following by Dr. John Iannarone, I believe.

SENATOR GERRATANA (6TH): Now I know what Zipnosis is.

DR. REBECCA HAFNER-FOGARTY: Great, I'm always glad to tell the Zipnosis story.

SENATOR GERRATANA (6TH): Thank you.

DR. REBECCA HAFNER-FOGARTY: Senator Gerratana, Representative Ritter and members committee, thank you for the opportunity to provide testimony S.B. No. 291. I, I feel a little bit like a voice in the wilderness because I'm going to speak in favor of it. My name is Rebecca Hafner-Fogarty, I am the Chief Medical Officer of Zipnosis. Zipnosis is a Minneapolis based telemedicine company. We've been in operation since 2008. Unlike many telemedicine companies we do not provide telemedicine services directly to patients. What we do is to provide a software platform that we license to our health system partners allowing them to use local providers in their own communities to offer telemedicine as an extension of a continuum of care in their community and their state. We currently operate in Massachusetts, Wisconsin, California, Minnesota, Alabama, Texas and a couple of other states and we're very proud that we are working and have partnered with St. Vincent's Health System here in Connecticut. Because I am still a practicing family physician I strongly believe in the concept of continuity of care. But we don't live in an ideal medical world. Physicians in Connecticut and across the country including Minnesota, sometimes have to treat patients in urgent care centers, emergency rooms and a variety of other settings where we don't have access to the patient's medical records. We're trained to take a history, do an appropriate exam when necessary and use other resources as available and appropriate, to do the best for our patients.

Part of what we do as physicians is to make judgments about resources, which resources are necessary to make those assessment and treatment decisions. If I have a very complex patient that I'm managing by all means, I need every single piece of information that I can possibly get my hands on and it may be worthwhile to delay making a decision abut treatment until I can review a complete record. That may not be true with a simple acute care/urgent care interaction.

I applaud the work that you did last year on your telemedicine law. I think you got it almost right, and the almost is that word 'and'.

From a policy standpoint and I understand and appreciate telemedicine and medical policy. I've been a member of the Minnesota Board of Medical Practice and I'm a past President of that organization. You've created a standard -- a different standard of care for telemedicine than you have for an in-person patient exam. You don't require an urgent care physician to have access to all of the past medical records of the patient before he or she treats that patient.

I'd like to say I think there is some language that can get us to a way that we support continuity of care, protect the patients of Connecticut and we, we've actually been in conversations with the medical society. We would be happy to continue that conversation because good medical policy means good care for your patients and it allow organizations such as St. Vincent's to increase access using this telemedicine as part of their continuum of care.

SENATOR GERRATANA (6TH): I, I thank you for that. Is this Dr. John Iannarone.

DR. JOHN TANNADORE: Senator, Representative Ritter and members of the committee.

SENATOR GERRATANA (6TH): I apologize. Okay, go ahead.

DR. JOHN IANNARONE: I'm a Board Certified Family Physician also and Clinical Coordinator for the St. Vincent's Urgent Care System. I was a skeptic regarding this program that we're using, and that's why I signed up to participate. We in fact have eight of our primary care physicians, four of our urgent care physicians, rotating calls. This just started last week. This system is different in that we are obviously in-state, we're part of the St. Vincent's multi-specialty group. We do have access to the patient recorded currently. And this system is very impressive in terms of having backstops in it so that if a person -- it's basically the patient is answering questions and along the line if for example they have chest pain, shortness of breath, it stops and then says you need to seek care elsewhere. They are not charged. If they get through that process to one of us, we g through the information, we do have the functionality to be able to have a face-to-face with them and if we ultimately decide to prescribe we can, we also can have them either come to either one of our primary care groups or to our urgent cares the following day.

So if I'm comfortable and I am my kids call me a late doctor, and I really am, I just got rid of my flip phone. So, you need to know that I am skeptical. I go into patient rooms without a computer. I prefer the face-to-face but I think this is worth a try. I have a 27 year old daughter who has an affordable care act high deductible plan and she thinks this is a great concept for her because she is able to access care. She works odd hours. She works in the theater. And it allows her perhaps to for $35 to be seen versus an ER visit that's much more expensive so I think that's a consideration as well. And I am free to take any questions.

SENATOR GERRATANA (6TH): Well thank you. Actually when I worked on this legislation last year you know there was quite a bit of discussion, but one of the things that came up was I was trying to understand and I think Zipnosis is similar to other telehealth providers that work with insurance companies and so forth. But what they do, do is that they provide telehealth for corporations and all you know, all kinds of individuals. But what they do is they do an intake. If there's a patient in the system that is covered by an insurance plan and I'm assuming you know that maybe Zipnosis is -- and I think I understand a little bit of what you do, is separate from working with an insurance provider. You go directly if you will, to the medical setting.

DR. JOHN TANNADORE: Correct.

SENATOR GERRATANA (6TH): And you provide medical expertise let's say I assume doctors you know or whatever. But one of the things that I know others do is that they provide telehealth to a population that's already identified and has a medical record available. So in other words, if a patient walks into some healthcare setting and is covered by X-Y-Z plan and they contract with a telehealth provider then there is access to that patient's medical records. But it would seem that, and I would ask the question that Zipnosis doesn't do that, has no patient contact if you will other than providing experts -- a direct relationship with the, either has a third party or in any other way as insurance companies have a relationship or access to patient information. So you're just providing if I'm correct, you're just providing an expert. And that expert can be consulted by in this case, St. Vincent's Hospital.

DR. REBECCA HAFNER-FOGARTY: Not exactly.

SENATOR GERRATANA (6TH): That's why --

DR. REBECCA HAFNER-FOGARTY: We're the Intel chip that drives St. Vincent's Telemedicine Service. So we're the engine that operates all of the software, all of the clinical decision support, all of the scientific algorithms the e-prescribing functionality the experts are doctors like Anna Rooney here, who are actually living and practicing in the community. They're the ones providing the medical care. We also have the functionality that whenever a telemedicine visit is done a record of that visit is integrated into the electronic -- existing electronic health record. We were the first telemedicine company in the country to do this and our unique interface with the EHRs is pretty much -- has pretty much set the standard for some other telemedicine companies.

SENATOR GERRATANA (6TH): Right, so given that there are electronic health records I'm trying to understand what the challenge is in -- I, I'm saying that I know we're not at the point yet, hopefully we'll get there very soon, where health records can be shared with anyone anywhere and at any time, and I know we're not there yet.

But aside from -- let me just follow up, I have another inquiry with -- aside from an emergency department, someone coming INT: the ED and seeking care and you don't now whether you have that person's health recorded but then again, you're seen by an emergency room doctor, this seems to me, it goes beyond the ED, this seems to me as though there could be a patient -- well, then you wouldn't really need -- I'm trying to really get a handle on this as you can see I'm struggling with it to understand why the patient's health record or the electronic health record or whatever, the medical record whatever you want to call it, is not accessible. What are the -- maybe you can help me that way, what's the situation?

DR. REBECCA HAFNER-FOGARTY: There are still a great many patients who don't have any electronic health record. They may not have, they may have only sporadic access to healthcare. They may be visiting in your state. I think the idea of universal interoperability is a wonderful, is a wonderful thing. I think that we won't find -- it won't happen in my lifetime and I know you're a lot younger than I am so I hope it happens in yours.

DR. JOHN IANNARONE: Also in the urgent care setting we see many folks who will say --

DR. REBECCA HAFNER-FOGARTY: Who just walk in the door.

DR. JOHN IANNARONE: Yes, and they -- and we'll offer, we have a referral service and we'll offer to set them up.

SENATOR GERRATANA (6TH): Okay.

DR. JOHN IANNARONE: They're not interested. There is no --

SENATOR GERRATANA (6TH): So, so doctor, isn't a history and physical taken at the time? Don't you -- isn't an assessment done?

DR. JOHN IANNARONE: Absolutely.

SENATOR GERRATANA (6TH): Because I'm trying to figure out do they just walk in and they're put in a room and they talk to somebody don a screen or in the urgent care center when the patent comes in, isn't there someone who does something and proceeds to establish if you will, a health record.

DR. REBECCA HAFNER-FOGARTY: Establishing a health record --

SENATOR GERRATANA (6TH): Just like a doctor's office or --

DR. REBECCA HAFNER-FOGARTY: Recording a chief complaint and a history of a present illness and a medication history and an allergy history, and an immunization history, that's all part of it. But, you may have --

SENATOR GERRATANA (6TH): Yeah, I would hope so because if you have allergies or something.

DR. REBECCA HAFNER-FOGARTY: Absolutely, but to require that you would have to be able to go back into a past medical record that may or may not exist or may exist in some other state has I believe the unintended effect of saying to very upstanding, reliable health systems like St. Vincent's that they can't open their doors and offer this service to patients outside of their existing patient rolls.

SENATOR GERRATANA (6TH): So okay, so then I would ask if the urgent care center when a patient comes in, you do take, you establish if you will, it could be someone who is never seen a doctor before or so to speak, or been in some sort of clinical setting, so there is no health record or someone from out of state let's say, and you can't, but you do establish, you do set up somebody sees that patient, they don't go directly to a screen and --

DR. JOHN IANNARONE: Oh no.

SENATOR GERRATANA (6TH): Okay, so a history and physical is done?

DR. JOHN IANNARONE: Yes.

SENATOR GERRATANA (6TH): And so that establishes a health record?

DR. JOHN IANNARONE: Correct.

SENATOR GERRATANA (6TH): Okay, well I'll have to look at the law again and I'll talk with the medical society but I, I appreciate and I think I got a better handle, so when that patient comes in, then is that patient, that patient is interviewed and a history and physical is done and then what happens to the patient with regarding Zipnosis?

DR. REBECCA HAFNER-FOGARTY: If a patient walks through the door of the urgent care center, they're going to physically see a doctor. If they access care through the telemedicine visit, they will be evaluated -- they will still be evaluated by a physician but it won't be in a physical, it won't be -- they won't be physically in the same room

DR. JOHN IANNARONE: I'm using my iPad like tomorrow I'm working and I'm on call for that. And what will happen is, someone accesses our system, goes -- you know and its symptom based, we have limited diagnoses currently. We're not going to diagnose your chest pain, you're abdominal pain that's going to stop immediately and we ask that they seek care immediately. It would be someone with a cough. It'll take them through a series of questions at any point shortness of breath high fever, chills, it stops and it says you need to be seen.

SENATOR GERRATANA (6TH): Okay, I may be very dense on this, and I'm sorry if I'm being -- but, patient comes into the urgent care center are we talking about a repeat patient? A first time patient? Are we talking -- because you're telling me that, that person physically walks in there and is interviewed by someone and a history and physical is done.

DR. JOHN IANNARONE: No, this patient is online from their laptop, they can use their iPhone to ask access us.

SENATOR GERRATANA (6TH): So now I get it, so this could be, so it is, it is on a screen.

DR. JOHN IANNARONE: Correct.

SENATOR GERRATANA (6TH): So the person may or may not go through in other, I know telehealth entities do, do a screening, they do get at the medical record and so forth. But Zipnosis or at least what you're talking to me about that's not what happens?

DR. JOHN IANNARONE: Right now --

SENATOR GERRATANA (6TH): That what happens is that someone can go on their iPad or their computer and the provider comes up and says okay, without any screening, without any sort of preliminary interview or any sort of health record?

DR. REBECA HAFNER-FOGARTY: Right now in the State of Connecticut St. Vincent's offers telemedicine services only to existing patients so the -- I want to be very clear that the physicians of St. Vincent's that are offering this telemedicine service to their patient's in the State of Connecticut are following the law.

DR. JOHN IANNARONE: I have access to a --

SENATOR GERRATANA (6TH): Oh yes, yes I'm not at all questioning that. I'm trying to figure out how this, how this works out, okay.

DR. REBECCA HAFNER-FOGARTY: So the patient provides the history, electronically.

SENATOR GERRATANA (6TH): And it comes from the patient, is that --

DR. REBECCA HAFNER-FOGARTY: And if his chief complaint, and it comes from the patient --

SENATOR GERRATANA (6TH): That comes from the patient, is that based on a form that they fill out or questionnaire?

DR. REBECCA HAFNER-FOGARTY: No, it's based on, it's based on an -- a software guided adaptive interview and that means that the questions change based on a very sophisticated branching logic. So the, the questions are different for every patient because they depend on the specific answers that the patient gives. The result of that are um, given to a physician at St. Vincent's physician to review and based on that review, the physician's review, the physician makes a decision about whether or not he or she feels comfortable treating the patient. Whether the patient needs to come in and be seen. Or, at several points in every adaptive interview, there are stop signs that require the patient to stop and come in and be seen, and a patient with symptoms such as urinary tract infection symptoms plus fever, chills and flank plain never gets to even be evaluated, by the doctor because they're not suitable, its not medically safe to treat them with telemedicine.

SENATOR GERRATANA (6TH): This is interesting, this sounds a little bit like a triage. Like a determination does this patient, when the patient goes and says, hey I got an awful cough or -- like I do, you know or something like that then, it's a --

DR. REBECCA HAFNER-FOGARTY: It's both triage and treatment.

SENATOR GERRATANA (6TH): It's a self-guided if you will questionnaire for lack of a better whatever you call it.

DR. REBECCA HAFNER-FOGARTY: Tool.

SENATOR GERRATANA (6TH): Tool perhaps to determine whether they have to see a physician or some other healthcare provider or not. What if it is someone who needs to see a physician or go to the hospital or something like that, I assume that they're told to do that. But if it isn't then what happens?

DR. REBECCA HAFNER-FOGARTY: Then the summary of that interview is evaluated by a physician such as Dr. Iannarone. And that physician still makes the decision about whether or not it is safe and it's both safe and effective to treat that patient based on the result of that medical interview.

SENATOR GERRATANA (6TH): And I, doctor are you at a remote site or something, or is this like an on-call thing or?

DR. JOHN IANNARONE: It is exactly, and I can be in my living room --

SENATOR GERRATANA (6TH): So there's an interaction between you, the software and the patient via the software?

DR. JOHN IANNARONE: Right, correct.

SENATOR GERRATANA (6TH): With the patient. Now I get it a little bit better. Okay.

DR. REBECCA HAFNER-FOGARTY: I also wanted to add that we are a Surescript certified E-prescriber, we have every prescription is totally e-prescribed. We have 86,000 pharmacies in our database. We have a very tightly controlled formulary. What we like to say is that the physicians can only, we give the physicians only right answers to chose from and there are no scheduled medications included in our formulary.

SENATOR GERRATANA (6TH): Okay, well thank you very much. I think Representative Srinivasan has a question or two for you.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you very much for your testimony and for the exchange that our chair and you had recently. You know, both of you made very interesting observations. You both are practitioners, you see patients, or you have seen patients if you are not seeing patients anymore. But the most, the key thing that you said, both of you all said, that when a patient walks in to an urgent care center or a walk-in clinic compared to the telemedicine it is a face-to-face. It's a hands on, that makes a world of difference. You're examining the patient. Yes, you're right you may not have the entire history, it may not be available, but that history that's not available you are more than adequately compensating by the fact that you're examining the patient. You get the history, you get the patient's version of whatever he or she knows about herself, and then you have the physical exam.

You already compromised it to a certain extent with telemedicine where you do not have the physical exam, and you're just it's just a visual. You are just you know, looking at the patient, talking to the patient and then coming up with a diagnosis. So already din medicine you have made one compromise and now to make one more where you say, we don't even need the records it is an optional I think is carrying it a bit too far. And having that information that, that valuable information when you're not able to do a hands-on examination of the patient, will only help.

Yes, you're absolutely right, you know you talked about somebody I think I was your daughter, I don't remember who you know is in the theater world and so she cannot go to the doctor regular and I get that. And now I'm sure you know that since you practice in Connecticut more and more of us have extended hours, and we are there on Saturdays, you know not you yourself, but the group is. So we are accommodating to the patient's needs.

So when we are accommodating to that, either you or somebody in your practice being able to see the person at not regular hours, not banker's hour but beyond the banker's hours, I feel this compromise that we are making, when all of this is cutting edge. I mean who knew ten years ago -- if you told me you're going to walk into a patient's room and be carrying a laptop, I would just laugh at you. You know such a thing doesn't happen. It happens only in the movies. But now it does, it's a reality.

So all of this is a huge change we are going through and to make too many rapid changes when we don't let -- down to me, is far too quick, far too soon. And either relying on the hands-on examination of the patient A, or relying on the full medical records before you make the diagnosis. So I'm not sure how you feel comfortable in compromising both the hands on and the non-availability of the medical records.

DR. REBECCA HAFNER-FOGARTY: One of the things that we have done is that we have out of the gate limited the number -- the conditions that we initially use this tool for to conditions where there is a significant body of medical evidence supporting the fact that it is both safe and effective to treat based on history alone and in doing so we, we follow national best practice guidelines about what questions to ask the patient, and how to get that information.

This is a tool that has a great, also has a great deal of additional utility. We've built a fleet of programs to help alleviate really difficult short fleet physicians for one of health system partners in Minnesota, and so you can really use this to increase ease of access for patients in a whole variety of specialties, not just acute care. Behavioral Health is another area where I, I'm sure in Connecticut like in Minnesota there's a, just a crying need for better access to behavioral healthcare, and we're working with a health system partner in Minnesota to build A behavioral health kind of tools that we'll be able to use with or health system partners.

The important thing that I, I feel very strongly about is that I'm not a big fan of direct to consumer telemedicine. I think it creates more fragmentation and just orphan medical records and that's why we do what we do, the way we do it, and partner only with health systems that have the bricks and mortar infrastructure to provide this new, cutting edge technology as part of a total continuum of care.

REP. SRINIVASAN (31ST): Thank you for that, for that answer. I appreciate that very much. And you make a very good point. A very, very good point that access is an issue, and there is no question about that at all. Whether it be mental health, or in remote areas or in specialties where it is very difficult to get a face-to-face because of the access factor. But we are not talking about access here. We are talking about not requiring medical records that's the part that I don't get. Access is a different issue, and saying that yes you can see this person for sleep apnea. Yes, you can see this person for mental depression or whatever the mental health issue is. But you know what? You can treat this person because you're just going to do a face-to-face and the established medical records of that person's sleep apnea, of their mental condition or whatever it is, is not needed, is optional. That's the part I have difficulty with.

DR. JOHN IANNARONE Many folks in this state do not have access or primary care and I see many folks in the urgent care setting who are unable to seek care because of at the type of insurance they have. Not all physicians take Connect Care, Medicaid to name a few. And we become the cord of last resort for them. And they use the urgent care as a primary, hence we do have a referral system to try to arrange care for them as they are able to accommodate their ability to afford it.

But we see the telehealth as a means of allowing them access to the healthcare system, to our health systems and it gets them in. At least an initial visit with a referral and we will help arrange follow up care for them.

So, many folks don't have records. We have many folks who come from other parts of the world or other part of the US without records. We always do our best to try to access those records. But I will tell you Representative, many folks have a difficult time accessing timely healthcare in this state.

DR. REBECCA HAFNER-FOGARTY: The language in the bill, requires -- the 'and' has the effect of restricting access.

REP. SRINIVASAN (31ST): I definitely get that, 'and' is the important word. That's the word --

DR. REBECCA HAFNER-FOGARTY: It's a very important word.

REP. SRINIVASAN (31ST): As you know me and -- in this building there's a big difference between me and shall. So the 'and' is a very important word, no question about that at all. But we are, once again, I think confusing the issue. We are already replacing a face-to-face, a hands-on, where you're examining the person with or without their medical records. You are already given that up, because we are doing telemedicine, and not a hands-on. I get you know, that itself is a big compromise. Now on top of that on that compromise, we are now saying the 'and' is not needed and you're leaving it optional. To me, it's too much of a compromise. Yes, access is important but access also cannot be at the cost of compromising both from a provider on the one hand, and what we are going to provide to the patient on the other.

So, your thoughts on the -- the need that you need not have the medical records, when you're not doing a hands-on?

DR. REBECCA HAFNER-FOGARTY: As I said in a -- the nirvana world of universal interoperability, we wouldn't be having this discussion. Until that time, I think that there are always situations when we have to do the best we can with the information we have. I also think that perhaps there is a different -- perhaps the discussion we're having between the word 'and' and 'or' might be better addressed by altering other language in he bill to address the importance of continuity of care and providing telemedicine as a tool and as a part of a whole continuum of care, which is what I think we will all agree is best for certainly my patients in Minnesota and I would argue for your patients in Connecticut.

REP. SRINIVASAN (31ST): Thank you very much and any language that you would like look at -- for us to look at, the committee would be more than grateful to look at that.

DR. REBECCA HAFNER-FOGARTY: And we are discussing with the medical society trying to come up with some language that would, that would allow St. Vincent to increase access and still meet the concerns of the medical society and of you and the committee.

REP. SRINIVASAN (31ST): Thank you. Thank you Madam Chair.

DR. REBECCA HAFNER-FOGARTY: Thank you very much.

SENATOR GERRATANA (6TH): And thank you.

DR. JOHN IANNARONE Thank you.

SENATOR GERRATANA (6TH): And thank you for your patience. We appreciate it. Next is Karissa Niehoff, from the Connecticut Association of Schools. Following by Suzanne Letso. Karissa? Okay so Karissa is not here. Suzanne come on up.

SUZANNE LETSO: Good afternoon, my name is Suzanne Letso and I would like to thank you all for the time to speak with all of you regarding S.B. No. 292., which is a bill currently to license both Assistant Behavior Analyst and Behavior Analyst. I think that you received a plethora of testimony about the need for this bill that to me I think I would synthesize by simply saying that it's a necessary bill for consumer protection. Behavior Analysts working with a wide variety of people including people with autism and other developmental disabilities but typically the audience that we work with are what I would consider to be vulnerable and not having a license I think is not necessarily the best scenario for those folks.

So rather than focusing my testimony on why they need it, what I would like to talk with you about is I would like to request a modification to -- several modifications actually. The first being that the bill be revised to be specific only to Board Certified Behavior Analysts at this time, not because Assistant Behavioral Analysts are not professionals or for any reason like that, but simply the primary reason is because in conversation with the Department of Health the cost to facilitate licensure for both of those categories of professionals is much more than what the department feels that they can handle either from a cost perspective or from human resources perspective.

So in conversation with them, they proposed alternative language where they feel that there would be some scope of practice protection for Assistant Behavior Analyst by tying them specifically to a licensed behavior analyst but we would keep the cost down for implementing this program.

The other exceptions are specific to doing a carve out for those individuals who are doing hands-on intervention with particular children with autism but a variety of other people as well. So a parent of another caregiver, a paraprofessional, someone simply implementing strategies. I, I think it's implied in the bill but it lies in the language so that it's specific. I wouldn't want to see insurance companies not funding those services any longer because those individuals are not licensed.

And lastly, I would just like to point out that while I know it's not a lot of money, over a four to five years we think licensure not only will do a great public service, but will also generate a net income for the state of about $900,000 if not more than that, and it's a time when we can't do a lot because our resources are slim, it would be nice to be able to both do something that protected consumers and generated some revenue for the state.

Oh, look at that, three minutes.

SENATOR GERRATANA (6TH): Thank you. Thank you so much. Does anyone have any questions? If not, thank you for coming today.

SUZANNE LETSO: Thank you. Thank you for the time.

SENATOR GERRATANA (6TH): Next is Neil Pearson, following by James Hoko, maybe? Thank you.

NEIL PEARSON: Good, good evening I guess now at this point. I know it's been a long day for you all but Madam Chair and distinguished committee members I do want to first thank you for allowing us and giving us this platform. I am here in support of Bill No. 292. My reasons for supporting this bill go beyond that of the behavioral analysis aspect of it. I am here as a special educator. I currently work with students on the autism spectrum. I work parallel to and tirelessly with behavior analysts, providing services to these students. I'm not going to sit here and talk about why we need this, I think that we need to look at it in a you know kind of, instead of you know looking inside the box, we need to you know make the box a little bit bigger here.

This is a standard of care issue. You know we need to provide credentialing that is uniform across the state for these individuals in this profession who are providing you know behavior analytic services to the consumer. And I think that you know, to say that we're living in a time right now where oftentimes it does come down to a fiscal aspect of the why legislation might not be put through. But I think that when we put a glass ceiling on the level of care that can be provided for these individuals who are already very vulnerable by just saying that you know, fiscally it's not within our means. I think we have to make it within our means to provide this prudentially. I have seen firsthand what it can provide for these individuals specifically those on the autism spectrum. And I know that there are horror stories out there of what can happen to consumers who are accessing you know, false services from people who are you know out there saying that they are credentialed.

So I think that this is -- this is a uniformity issue. This is a growing field. And I think that it would really, it would be something that I think that is very progressive for this, for the state of Connecticut in providing this credentialing. As a state educator, you know I would not be educating without you know the proper credentialing. Likewise I think that when you're dealing with individuals who are vulnerable, who oftentimes don't have a voice. It is the state's job to provide that voice and that voice for you guys would be approving this legislature.

So, I, I don't take this time for granted, I don't take your time for granted. It's -- you know I wouldn't be here if this wasn't important. So, you know I think -- that's all I have to say for right now, so.

SENATOR GERRATANA (6TH): Well thank you very much Mr. Pearson. We appreciate it very much.

NEIL PEARSON: Yes, alright thank you.

SENATOR GERRATANA (6TH): Thank you. Next is James Hoko, following by Melissa Saunders.

JAMES HOKO: Representative Ritter, Senator Gerratana and members of the Public Health Committee. My name is James Hoko, and I am here in strong support of S. B. No. 292, with the modifications that were mentioned by Suzanne Letso, a few minutes ago. I first came to Connecticut just out of graduate school in grad year 1988. And I currently reside in the town of Madison. My career began as a behavioral psychologist for area cooperative educational services or ACES. And at that time I was supervising three individuals. A lot has changed since then, and now I direct a behavioral services division that numbers more than 130 individuals. Serving dozens of school districts and private residences. For nearly three decades I've either collaborated on, provided or supervised the provision of behavior services for many, many Connecticut children and families who face very difficult and challenging situations. Children hurting themselves, children disjoined from all social contact, and children faltering unnecessarily due to unavailing educational opportunities and interventions.

I have witnessed situations with miraculous endings and situations ending in collapse and despair. The happy endings typically involve individuals with very specialized training and experience. While the sorrowful stories involved individuals lacking the true expertise to create any meaningful change. These individuals often carry titles false implying competence, such as behavioralist, behavior specialist, and behavior management director. While Connecticut has a law that protects the title of Board Certified Behavior Analyst, it has nothing in place to protect families and individuals from misleading titles and false promises. The work yet to be done, the work already completed by 26 other states, is to ensure that individuals offering behavior services are actually trained, experienced and competent in providing those services. I am licensed as a behavior analyst in both Massachusetts and New York, although I don't intend to work there. I do it rather as a statement of the importance of licensure for protecting families and children who are behaviorally challenged. I beseech Connecticut to do the right thing for its residence and put licensure in place for delivering behavior analytic services that are so essential to Connecticut's families. Thank you.

SENATOR GERRATANA (6TH): Thank you very much for your testimony we do appreciate it.

NEIL PEARSON: Thank you.

SENATOR GERRATANA (6TH): Next is Melissa Saunders following by Kristine Marino.

MELISSA SAUNDERS: Thank you Representative Ritter, Senator Gerratana and the members of the committee. My name is Melissa Saunders, I'm a licensed behavior analyst in the State of Massachusetts. I'm also the executive and a Board Certified Behavior analyst, and the Executive Clinical Director of Creative Interventions. We provide services throughout the State of Connecticut, ADA services. I'm in support of S.B. No. 292, I agree with Suzanne Letso's recommendations fully and I'm not going to repeat all of them. I think they were summarized very well. You know the one thing I just want to say that's really important is the state recognized that ADA services were an important enough service or provision to make a mandate on that. They need to recognize that now we need to take the next steps. Just as James said, there are 25 other states that recognize that. Consumer Protection is why we're here. And consumers are not sure who these people are that are coming in and there is no law that prevents misrepresentation at this point, if you say you're a behavior specialist or all of those things. Or if you're practicing even as a Board Certified Behavior Analyst and you engage in conduct that isn't reputable or you harm the child, there's no, there's lots of challenges there. And I really think it's important for consumer protection to really move this forward at this point. Align ourselves with the other states. It's inevitable, and I think it's something we need, too. That's it, do it.

REP. RITTER (1ST): How many states licensed?

MELISSA SAUNDERS: Twenty-five I think.

REP. RITTER (1ST): Thank you, twenty-six I hear. Wade Boggs for the Red Sox.

MELISSA SAUNDERS: just kidding, 26.

REP. RITTER (1ST): Thank you.

MELISSA SAUNDERS: So yes, it will be 27.

REP. RITTER (1ST): Kristine Marino, thank you -- following by Missy Olive.

KRISTINE MARINO: Good evening, thank you very much for allowing the opportunity for me to testify this evening. We are, as you can tell very happy and excited that this bill is being raised, S.B. No. 292. Not to repeat everything that my colleagues before me have said, but I would definitely echo all of their sentiments and I would agree with Suzanne Letso's recommendation for revisions to the bill, and I would like to just reiterate that, um, the point that you've heard a couple of times already that um, within or field currently we have a national certification but in the State of Connecticut because there isn't a state recognized credential at this point, our families can become easily confused when they're searching or services, by titles that can sound very similar to ours such as behaviorist or behavioralist. And I have unfortunately witnessed in many cases first hand, some of my own students wither before coming to me or when seeking home services, receiving services from somebody who didn't have proper credentials and who were not effective and that means you know, valuable time and money, and often emotional costs for the families and of course for the student who is receiving the services. And so, you know I would just agree and echo, as I said, that I feel that this is a very important bill for consumer protection. We appreciate that you're raising it, and please pass it. And thank you very much for your time.

REP. RITTER (1ST): Thank you for your testimony. Missy Olive, and then we're moving onto Senate Bill No. 295, I'm sure they thought this day would never come. Dr. Andy Salner I believe left but if he's here still -- no, he came back, great thanks.

DR. MELISSA OLIVE: Hi, I'm Dr. Melissa Olive, I go by Missy and I'm going to wear two hats today if that's okay. I'm going to start off with the hat representing the Organization, Connecticut Association for the Behavior Analysis. I serve as the Chair, Co-Chair of the legislative committee. I'd like to highlight that and Dr. Mark Palmieri has already submitted written testimony on behalf of the organization so I just wanted to highlight a few of the points from his written testimony. And we are a professional organization and we represent over 545 BCBAs and BCABAs. We also have another 183 registered behavior technicians. So it's a lot of individuals who are either supervising behavior analysis or implementing it directly. The organization itself is in support of 292 because it will provide additional protection for consumers and also because applied behavior analysis the intervention that we implement it is an empirically based intervention, and is widely used among children with autism and other developmental disabilities. But because the individuals we serve are so at risk and vulnerable, it is important for them to have that extra layer of protection by a state license, and others have said, 26 states already have that license.

It's important to note our surroundings states have it. So it's Massachusetts, Rhode Island, and New York. The organization itself would like to ask that you all add the exclusion for the direct serve staff who implement as well as families who may implement the plans that are supervised behavior analysts. And this bill would not effect the scope of practice of other practitioners in the state who are licensed psychologists or speech and language pathologist and so forth. I'm going take off that hat and put on my own hat.

I am a doctor level behavior analyst and I'm also a licensed behavior analyst in this state and New York. I need to catch up with Dr. Hoko and get my Massachusetts license too. I am the Executive Director of Applied Behavioral Strategies. We are an agency that provides behavior analytic services to children, particularly children who are service under Public Act 09-115. I do just want to add another story from, from my coffer about the importance of having appropriate licensure. I currently serve a child who had been served by a woman who presented herself as someone who had taken all the course work and then the child ended up in my lap, he was engaging in serious aggression towards the teachers in his school, and the parents not being informed of appropriate licensure and certification believed her because she touted herself as someone who had taken the classes. And so you know that is just an example of the importance of appropriate licensure and having the courses and follow through from the state.

REP. RITTER (1ST):..Thank you. Any questions? Seeing none, thank you very much for your testimony, and everybody on that bill.

DR. MELISSA OLIVE: Thank you.

REP. RITTER (1ST): Dr. Salner following by Dr. Russo on Senate Bill No. 295. Thank you. Dr. Salner, nice to see you. How are you?

DR. ANDY SALNER: I am fine thank you Representative Ritter, thank you. Distinguished members of the Public Health Committee, my name is Dr. Andy Salner, I'm Director of the Helen and Harry Gray Cancer Center at Hartford Hospital. This evening I'm testifying as a volunteer of the American Cancer Society's Cancer Action Network. In 2016, it's estimated that 21,700 Connecticut residents will be diagnosed with cancer while 6780 will actually die from the disease. The American Cancer Society Cancer Action Network supports S.B. No. 295, AN ACT CERG RADIOLOGIC AND IMAGING SERVICES. The bill requires the Commissioner of Public Health to conduct a study of the impact on patient access to care due to changes in reimbursement for radiologic and imaging services as scribed in Medicaid State Plan Amendment 15-020. The commissioner would be required to submit a report on the results of the study to the legislature by January 2017.

As part of the painful cuts made last year, the reimbursement methodology and Medicaid State Plan for radiologic and imaging serves were reduced by 42.5 percent. The governor's FY17 Budget Revision 6, to make those cuts permanent. While implementations ongoing the impact will likely be significant. Especially in areas with smaller hospitals and lower capacity. Medicaid rate reimbursement cuts are leading to fewer providers accepting new Medicaid clients and coupled with new Medicaid -- non Medicaid cuts to hospitals, that have already lead to reductions in services to patient's appropriate and adequate access to patient care s threatened. Imaging services are used for all of our cancer patients in terms of their screening, their diagnosis treatment and surveillance. These cuts like other cuts to Medicaid will likely compromise the care we provide to our cancer patients The study called for in S. B. No. 25, will provide a clear picture of the impact on patient access as well as recommendations for improvements. We urge passage of the bill. Thank you very much.

REP. RITTER (1ST): Thank you doctor. Any questions from the committee? Representative Srinivasan?

REP. SRINIVASAN (31ST): Thank you Mr. Chairman. Thank you Dr. Salner for being here this afternoon in this voluntary capacity of yours. And you mentioned the percentage in this reduction was which obviously hit the radiological group excessively. The cut that has happened to all services have they been that steep or is it this service that is being hit so hard?

DR. ANDY SALNER: It's my understanding I don't know about all the cuts by specialty but it's my understanding that these cuts were rather more rather than many of the other cuts that have happened. And that's why I'm particularly concerned about access to imaging for or patients.

REP. SRINIVASAN (31ST): Thank you very much and that access is definitely a big concern for all of us. We heard earlier in the day one of the representatives tell us, that the cost now reimbursement costs for the chest x-ray was about $6 or something like that, and he even made the comment that it cost more to send out a bill you know from the billing point of view than collecting. And you know if these cuts, continue and there is no other change in that, I cannot even imagine what impact it will have and that everything, will then be directed back to where we do not want them to go, back to the emergency rooms and everything else and obviously the study is important information for us to work on and see what impact it has had, so thank you very much.

DR. ANDY SALNER: Thank you.

REP. RITTER (1ST): Thank you and doctor, please give my best to Matt.

DR. ANDY SALNER: I will, thank you.

REP. RITTER (1ST): And also I would add to that, if anyone is wondering you know I know there is some reservation about the actual tax, and why we're not looking at amending Title 12 and again, we have our committee, we have our things of cognizance with what we do, Finance have things that they do as well, so thank you.

DR. ANDY SALNER: I appreciate it, thank you.

REP. RITTER (1ST): Yeah, Dr. Russo, following by Jacqueline Roberts.

DR. ROBERT RUSSO: Thank you, good afternoon Senator Gerratana and Representative Ritter and the obviously hardworking members of this committee. I can't remember the last time I was here, I was over telemedicine so it's nice to move on but if there are questions I could answer them later. I'm here in support of Senate Bill No. 295, basically this is an ask, because we can't get data. There's an old expression that the multiple of anecdotal stories is not research and we've been greatly affected by the Medicaid cuts that came out in the last budget. To give you a simple lesion, there's difference in different types of medical practice.

The radiology practice from a business standpoint is basically a high volume, low margin business. We do a lot of studies with a small margin. So when you come in and cut it 42 percent, of course you drop below the margins, we were already below the margins with Medicaid but now we're at the point that it hurts. And what's happening is on the ground, the boots on the ground type clinical stories of people here, basically what we see access changing dramatically. I'll give you one anecdotal story because that's why we're here trying not to be anecdotal but to get somebody to put it altogether. The City of Bridgeport has one low cost CAT scanner in. It's moving out in April. It has two other low cost scanners right on its border. Now they're on the border because if you're in Bridgeport you pay a high rate from property tax so people put them right outside. Two of those are closing. So the city alone in Bridgeport will lose three CAT scanners that actually service not only the Medicaid population and here comes the next problem.

When we talk about Medicaid, we talk about a specific group of people that aren't really specific because surrounding them in their same cadre are the uninsured, the illegal aliens, and the under insured that had these very high deductible plans. And if you're making $35 or $40,000 and you live in Fairfield County and you have a $5,000 deductible you basically don't have insurance. Especially when it comes up against these advance imagings, some of which go from anywhere from 50 to 3000. So we can't get data. We went, I went to DSS. DSS sends you to DPH. DPH sends you back to DSS, who sends you back to the budget. And here's what's happening, every time we say well we're not seeing the effect. Well, you're not seeing the effect because you're not looking.

It's very important that we know, I mean I also sat on the SIM Equity and Access Council. We're looking at access to this type of care, and we're seeing, not SIM, but we as the physicians are seeing a real access problem and all we get back is well prove it. Well the people that can prove it, are on the other side of the table. Why we're in front of you, is to get you to ask them to study the problem so we would have data and it won't be all these anecdotal stories.

SENATOR GERRATANA (6TH): Thank you Dr. Russo. Thank you for your input. We certainly appreciate that in support of the bill. Does anyone have any questions? Representative Srinivasan.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Dr. Russo for being here this afternoon. So this impact with this drastic cut, you know this anecdotes that you said don't add up to the real story and so we really need the true story. What has been your experience so far in terms of access from an anecdotal point of view?

DR. ROBERT RUSSO: Well I think that's what the physicians are saying, the radiologists in particular are saying that these people are not getting care. Uh, the cancer specialist that spoke earlier said, my cancer patients need this care, and if it's not available, and if you go back and look, the private practice of radiology is actually the most efficient practice of radiologist, and always -- and you drive those out of business what happens next? You drive them into the bigger systems. It's a higher cost. It's going to use up more of the Medicaid dollar instead of spreading it towards the cancer or heart or whatever else is out there. So all we're saying is understand what radiology is. It's a high volume, low margin business. If you undercut it to put it out of business, you will succeed. It will be out of business. Now put on the doctor, they say what about my patients? How do my patients get to see the radiologists for the studies they need, and whose responsible, without data. I mean, physicians are scientists, give us the database and we can help solve the problem. Without a database without somebody saying, where is this patient is done? What are we paying for it? How often and who doesn't get to it? There's -- the argument gets weaker because it sounds like whining. I mean, I've been told a couple of times the radiologists just want more work. The truth is, when you're losing money doing these patients you're not really looking for more work. You're looking to help the patients that we became doctors to do. We're not looking to survive on Medicaid. We cost shift to keep Medicaid alive, there is no question about that. But you've made it so, not you but whatever the process is, has made it so that I am worried. I'm a retiring radiologist. It's not going to make any difference to me. I am worried about, what about those patients in the cities, the inner cities not only Medicaid, remember the Medicaid pool shrinks by and grows by what you allow it to do. So the uninsured come in and go out. They're suffering at the same time.

REP. SRINIVASAN (31ST): Thank you so much, Dr. Russo.

DR. ROBERT RUSSO: Thank you.

REP. SRINIVASAN (31ST): Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you so much. Are there, I don't think there are any other questions, so thank you for giving your testimony today. Next we have Jacqueline Roberts, from Sisters Journey, following by Dr. Thomas Farquhar.

Welcome Jacqueline.

JACQUELINE ROBERTS: Thank you, just one correction, I'm Jacqueline Roberts from Nubian Sisters Cancer Support Group. It is also a 501C3 support group that seeks to aid and support women diagnosed with and who have had cancer. I'm also on a committee for the NAACP where we're working on a study now to help -- to see that women that have, are 29 to 39, so that they can receive ultrasounds to see if that's the treatment that they should use to help determine if they have breast cancer. And I am myself a two year, a two time breast cancer survivor. I'm a two time breast cancer survivor so this is a personal issue for me. So I came up to Hartford today because I was very concerned. The radiology and imaging costs/cuts that the state made is being felt in the community. Cuts to Medicare reimbursement for imaging services with limited access to care for Connecticut's most vulnerable patients. I was stunned to learn of this last year. These are very large reductions in the fees that are paid t radiologists for tests like mammograms. In some cases this means they receive $10 or $20 per reading patient images. Because of this, many offices are closing and have reduced their hours of appointments. I know of two centers have closed in Hartford and there are several that are closing in Bridgeport.

This is hitting our cities hard. The more I look at these cuts, the more they look to be pennywise and pound foolish. I heard that this could even cost more patients to be sent to hospitals for their mammograms or tests. This only costs more. These cuts total millions of dollars but do we really know what is happening out there? Who is going to watch to see or to make sure that people aren't hurt in the process? I think this bill is a good start. These are lifesaving tests. And let's get the data we need to figure out how we can fix the problem. Thank you.

SENATOR GERRATANA (6TH): Thank you. And thank you for your testimony, we do appreciate it. Thanks for coming today and waiting to give it. We really do appreciate your input. Thank you, Dr. Thomas Farquhar, following by Betsy Gara.

DR. THOMAS FARQUHAR: Senator Gerratana, Representative Ritter and members of committee thank you for taking the time to listen to me today. My name is Thomas Farquhar, I'm a medical doctor who practices radiology here in Hartford with Jefferson Radiology. I'm also the legislative co-chair of the Radiological Society of Connecticut. And I'd like to thank your commit for considering Senate Bill No. 295 to try to quantify the effects that the decreased reimbursement to radiology providers will have on radiology and imaging services for Medicaid patients. So as other have mentioned and I'm sure you are aware, this year's proposed would continue the drastic payment reductions made last year to the provider component of Medicaid payments for imaging like ultrasound, x-rays and mammography.

The Radiological Society of Connecticut applaud this bill's attention to this issue because we are very worried that decreased reimbursement will ultimately limit Medicaid patient access to these vital services. Now to be clear, these cuts targeted only private practice radiologists. Not hospitals. And with this in mind private practice radiology practices Dr. Russo had pointed out are small businesses, employing hundreds of employees with good paying jobs in communities across the state. And as Dr. Russo also highlighted, private practice radiology differs from many other subspecialties in that it requires very expensive capital costs for the imaging equipment and technology that we use on a daily basis. So at that same time many of the radiology exams even though it's a subspecialty these are screening exams, like mammography or the first step in an outpatient workup of a common medical issue, and convenient access to these exams is crucial to be able to render both preventative and primary medical care, avoid ER visits and hospitalizations. Recently the Susan Komen Foundation announced that Connecticut now has the highest incidents of breast cancer in the country. Is now really the time to hamper access to screening exams like mammography? DSS has said publically that these rates are in line with neighboring states in New England and this is simply not true. In fact these rates put Connecticut Medicaid payments among the lowest in the country on par with only a few states, like Mississippi. And the eventual outcome of continued provider cuts is very clear. Medicaid patients will have few if any non hospital providers excepting their insurance, driving them to hospitals even for routine outpatient and screening exams. At greater cost and much less convenience. We've already seen a private practice in Meriden announce that it will no longer accept new Medicaid patients. In July of 2015 one of the two private practices in the City of Hartford closed, leaving only hospitals and just one, single remaining private practice as options for the patients. Decisions such as these to turn away patients and close offices are not easily undone. So I believe that many private practices are hopeful that these reimbursement cuts can be at last partially restored and thus are waiting before they make more difficult decisions. I believe that if action is not taken this session we'll see further narrowing and erosion of access for Connecticut's most vulnerable patients to outpatient screening imaging exams. And so again, that's why the Radiological Society of Connecticut strongly supports this bill. And we thank you the committee for its efforts and attention in this matter.

SENATOR GERRATANA (6TH): And thank you for giving your testimony, we appreciate your patience.

DR. THOMAS FARQUHAR: Thank you.

SENATOR GERRATANA (6TH): And Representative Srinivasan has a question.

REP. SRINIVASAN (31ST): Thank you Madam Chair. Thank you Tom for being here this afternoon, and for all your advocacy. So in your observation if I heard you correctly, you're saying with these cuts, with these deep cuts, what you are seeing A, is a closure of these private practices in terms of accepting patients on Medicaid for their radiological services. So these patients A, don't get the service number one, and then what happens? They go to the hospital where what happens to the cost of the radiological services?

DR. THOMAS FARQUHAR: Absolutely, we've already seen a few of those changes but I fear that's kind of the tip of the iceberg and that while others hold out hope that this could be reversed. Closing an office is not something that can you know just turn around and undo quite quickly. It's the closing of a business, a lot of leases. Staff get fired, and things like that. And so my fear would be as this if this were to continue and not be able to be fixed it's almost coming up to the one year anniversary from when the cuts began. I do believe that this will just kind of be the tip of the iceberg and that we'll see more office closures with more offices taking the difficult decision to no longer see any Medicaid patients.

REP. SRINIVASAN (31ST): And when these offices take that difficult decision of not accepting these patients because they're unsustainable, then those patients either don't get service number one, or B they do get service, they'll have to go to a hospital based radiological service?

DR. THOMAS FARQUHAR: Very true, and as you know for example from Glastonbury, if there's no hospital nearby on that side of the river, and you're patient doesn't have easy access to be able to get places, if you don't have an outpatient private practice radiology practice to be able to go to for something as simple as a chest x-ray when you have a cough or your routine screening mammogram, you would be forced to go to one of Connecticut's roughly 30 acute care hospitals for what should be a relatively simple, straight forward screening or outpatient exam. And that's exactly what we would fear would happen.

REP. SRINIVASAN (31ST): Thank you Tom, and as you said, you know when you mentioned that there was a radiological group that closed down in Hartford, I feel the pain. They're right in my building.

DR. THOMAS FARQUHAR: Right.

REP. SRINIVASAN (31ST): And then, so those patients that you would so conveniently send them to get a service done, now we've got to scramble and either send them to a hospital or somewhere else who is accepting them. So, even without the study, I already feel the pain. But it is important for us to k now this information and I think that this study will help us get that information so we take the necessary steps. Thank you for all of your advocacy.

DR. THOMAS FARQUHAR: My pleasure, thank you.

REP. SRINIVASAN (31ST): Thank you Madam Chair.

SENATOR GERRATANA (6TH): Thank you. Representative Demicco has a question.

REP. DEMICCO (21ST): Thank you Madam Chair. Thank you doctor for coming to testify. I just want to make sure I am reading your testimony accurately. So in your testimony and you know just now you're telling us that contrary to what DSS claims that this decrease in reimbursement actually puts us pretty far below the average of surrounding states, is that right?

DR. THOMAS FARQUHAR: Yes sir, so I had previously presented to the MAYPA Committee, and I can send a link to the data that we had there showing -- I couldn't get data from Rhode Island but for the five most common exams in neighboring other New England states it was all much lower. The most strikingly out of line exams are for screening, mammography, diagnostic and screening mammography, in which case we were somewhere between 50 percent and 80 percent of New York and the other four New England States that I had data for. They were all lower despite the higher costs compared to states like Vermont, New Hampshire, Maine.

REP. DEMICCO (21ST): Well, just -- based on what you're saying, it seems to be there had to be another reason you know, would you happen to know what the other motivation or rationale was for instituting these reduced rates?

DR. THOMAS FARQUHAR: So I don't -- okay, so to back up, so we had extensive after the rescission, we had extensive meetings with DSS in which we questioned their methodology. It went for a while, Representative Becker was actually an advocate for us there for several of them. And we pointed out to them several other exams that they were paying sometimes up to seven times Medicare rates for, that they weren't aware of. They went back and looked at those and said oh, those were codes we, I guess we meant to fix, thanks for pointing them out to us. They never said -- I don't know that there was a rationale or a logic behind it. As a scientist and physician I don't know that they looked at the exams that were the most over utilized and cut them down. They cut straight forward, screening, preventative services like mammography to the lowest rates in the country. And I don't think anyone would do that on purpose. So I don't know what the rational methodology would be.

SENATOR GERRATANA (6TH): Thank you very much and thank you for your testimony again. Betsy Gara I guess is not here so we go to Shirley Olson, followed by Ashika Brinkley, on House Bill No. 5457.

SHIRLEY OLSON: Good afternoon.

SENATOR GERRATANA (6TH): Good afternoon.

SHIRLEY OLSON: I wish to thank the committee for taking on the challenge of District Health Department. My name is Shirley Olson, I'm a licensed registered nurse. I live in Portland and am a member of the Chatham Health District. Selectwoman Bransfield was here this morning and I'm not going to reiterate the information that she provided. When I was beginning nursing school one of the very first things taught was the World Health Organization definition of health.

Health is a state of physical and mental well being and not merely the absence of disease or infirmity. Based upon my personal experience I readily agree with the intent of this bill given the recent problems and events in the Chatham Health District, it is necessary to include the supervision, the oversight and the enforcement by the Department of Public Health.

At the time of the Director's abrupt departure I was quite disappointed that DPH did not appoint an outside experienced interim director who could have objectively evaluate the entire system and the problems within the system. And listening to everyone speak about the risks for the children, you can't solve the problem of how to take care of these children and everything if you don't have the facts.

Further, without a licensed physician with public health credentials and CEO, how can specific ongoing health issues and problems and trend as well as emergent health issues and problems be identified and diagnosed. It's a specific difference between medical practice and public health practice, and they have to be merged together, to effectively take care of the communities. If I applied for a health district position and my clinical skills and expertise were going to be required, I would ask to whom do I report? If the answer was a non clinical intermediary I would not take the position. Professional health licenses are the jurisdiction of the Public Health Department. Would DPH protect me in the case of an incident based upon someone else's decision making? I worked in three large major insurance companies in rolls requiring clinical decision making, I always had direct access to a physician.

SENATOR GERRATANA (6TH): Thank you Miss Olson, can you summarize, please?

SHIRLEY OLSON: I believe that there is much more to be reviewed in this entire matter. Thank you.

SENATOR GERRATANA (6TH): Now that was at the end of our testimony I saw you skipping around.

SHIRLEY OLSON: Yes.

SENATOR GERRATANA (6TH): So thank you so much. Thank you for giving testimony.

SHIRLEY OLSON: You're welcome.

SENATOR GERRATANA (6TH): Does anyone have any questions? Representative Carpino does.

SHIRLEY OLSON: May I -- oh, okay.

REP. CARPINO (32ND): Thank you Madam Chair. In my district we are well aware of the three minute rule so we try. Shirley I know you've been here all day. So I really do appreciate it and I know you speak for a number of the members of the Portland Community. It is unfortunate that the members of Portland had to deal with what happened to Chatham Health District and a lot of it came at the tail end, when there was very little that we could do as community members. I know you want to see us go a little bit further. I agree with you that this is a good first step. We have to be careful that we don't um, punish other health districts who are doing the right thing.

SHIRLEY OLSON: I, I understand that.

REP. CARPINO (32ND): Do you have, and if you don't have it with you today, if you want to send it over to me, if you have specific items that you would like the committee to consider as this bill moves on, I know that we're always happy to take additional written testimony past today.

SHIRLEY OLSON: Okay, I, I'm thinking more globally about it, just the district needs to be evaluated in total after what? The length of time that Director of Health was there, for instance how many other people in that building knew what was going on? Did they participate in that? I mean those are questions that really need, I believe, need to be answered? And before -- I mean I understand perfectly what you said to Mrs. Bransfield about not overburdening the system. But I really believe that after the length of time that it had been going on, that the problem underling situation, has to be clearly defined so that you can go forward without creating new problems and making regulations that perhaps don't necessarily need to be.

REP. CARPINO (32ND): Thank you and I agree, and I personally believe that the DPH should do a periodic audit or review of the health districts perhaps on a rotating or random basis. And that's something that I hope to give consideration. But thank you very much for coming.

SHIRLEY OLSON: Thank you very much everyone for listening to my little story.

SENATOR GERRATANA (6TH): Thank you. Thank you so much. Next is Ashika Brinkley, following by Kathy Kennedy.

ASHIKA BRINKLEY: Good evening. My name is Ashika Brinkley and I'm the Executive Director of the Connecticut Association of Directors of Health, CADH, representing Connecticut's local health directors. We would like to thank the co-chairs of the Public Health Committee for sponsoring this bill and for continuing to recognize the important role of local public health. Current statutes carry language regarding municipal and district health directors are inconsistent with regard to the time required of their position. This bills aligns that language and clearly articulates that district directors shall serve in a full time capacity. CADH opposes the language prohibiting directors of local health districts from additional employment beyond their full time commitment.

Directors of municipal health departments are not subject to a similar restriction despite the fact that we have the same statutory requirements and authorities. We understand the importance of avoiding conflicts of interest, but this prohibitive language would disallow any employment including teaching at institutions of higher education. Teaching in particular is an important part of workforce development. Assuring a competent public health workforce is an essential function of local public health.

Engagement in professional development activities, particularly with emerging publ. Health professionals allows for health directors to develop new insights and innovative solutions to health problems. Municipal health directors are not prohibited from engaging in college or university instruction, research and other supplemental employment. There is no rationale for this restriction only applying to local health district directors. Directors of health districts are as committed as their peers in municipalities to delivering essential public health services.

Thirty years ago the state the state passed legislation to provide incentives for smaller towns and municipalities to create districts to provide full time public health services. All of our health directors are equally committed to meeting their obligation to protect public health and ensure public safety with dwindling resources whether they're in local health departments, municipal health departments or health districts.

The language in the statute should reflect that similarity in duty and commitment to local public health and as such, there should be no difference in the definition of full time employment across these entities. Having different restrictions on personal time, methods of performance evaluation and supervision for health directors and health districts will serve as another barrier to the creation of additional health districts in Connecticut.

CADH also opposes the type of supervision of local health departments by the State Department of Public Health as described in House Bill No. 5457. We think the additional language to provide close supervision oversight is unnecessary. The relationship between State and local health is already articulated in Statute 19-2A. Local health districts are already under the supervision of local boards of health. Thank you for your time and consideration.

SENATOR GERRATANA (6TH): And thank you very much. Representative Ritter has a question, I believe.

REP. RITTER (1ST): Thank you Madam Chair. I'm confused, so this bill came to us from the first -- Section 1, came to us from the health directors asking us to do it because of an Attorney General payment in the mid 1990s where there was a difference in the language of the regional health districts have the language, should be a full time capacity, and they said that they wanted to be the local health records wanted to be consistent because there was an AG opinion which talks about devote entire time and what that means versus full time capacity.

So I'm confused because we're now making it the same for both, which mean that full time -- the way that AG looked at it was, it says devote your entire time. You can do nothing else. You couldn't work on Saturdays part time as a bartender for example. So we're just trying to make it consistent. So I, whoops did we make a mistake, I don't know. But this came from the local health directors. Anything you can help or share with --

ASHIKA BRINKLEY: I just wanted to -- so the clarification is that both local health districts and municipalities should be allowed to work full time, meaning that full time in their health department, but allowing them to also have additional employment. So the way it's written right now, health districts cannot by the definition of, 'entire' time' prohibits health districts only from having additional employment whereas local health -- municipal health departments do not have that restriction.

So if the full time language means that we both can have outside employment then it's fine. But if, but the way we're reading it -- we didn't read it that way. We read it that yeah, the way that we read this, it didn't read as though there was a -- it didn't read as thought there was standardized language for both districts and municipalities. It still sounded as though there was a distinction between the two.

REP. RITTER (1ST): Right. So do me a favor before you guys lose this opportunity which I think some of your members requested.

ASHIKA BRINKLEY: Yes.

REP. RITTER (1ST): Let's take a look at Line 20, which talks about we're adding such directors shall serve in a full time capacity. We're then deleting the language 'devote his entire time' okay?

ASHIKA BRINKLEY: Okay.

REP. RITTER (1ST): Which is what I think you guys are exactly what you're saying which is, let me be a coach, let me do something else.

ASHIKA BRINKLEY: Right.

REP. RITTER (1ST): We want to help you get that, because I get it.

ASHIKA BRINKLEY: Okay.

REP. RITTER (1ST): And there should be no difference that's what we're trying to do.

ASHIKA BRINKLEY: Okay.

REP. RITTER (1ST): So if we're not, let us know. But we're trying to help you guys because the story that I heard made complete sense to me. Again --

ASHIKA BRINKLEY: Okay.

REP. RITTER (1ST): The distinction came from the 1995 opinion and we're just trying to rectify that. So any feedback that you can get to us, to myself and the ranking members of my co-chair, we'll try to make this work. But we are trying to get to the same end and we're working on that, okay?

ASHIKA BRINKLEY: Alright, great. Thank you.

REP. RITTER (1ST): Thank you.

ASHIKA BRINKLEY: We'll do that. Thanks.

SENATOR GERRATANA (6TH): Next on Senate Bill No. 296 is Kathy Kennedy, following by Lucy Nolan, following by Jennifer Harris. Kathy Kennedy? Okay, Lucy Nolan? Jennifer Harris, here we go.

JENNIFER HARRIS: Good evening, thank you Senator Gerratana, Representative Ritter and members of the committee for allowing me to testify on S.B. No. 296, specifically the recommendations of the Childhood Obesity Task force, on food marketing to children in schools. My name is Jennifer Harris, and I am at the Rudd Center for Food Policy and Obesity at UConn. I direct our research on food marketing to children and teens. And I want to thank you for addressing the issue of food marketing to children in schools. It's one of the most common forms of food and beverage marketing to children and unfortunately nine out of ten of the dollars spent on this type of marketing are for fast food and sugary drinks and other unhealthy products. We also have surveyed parents and we know that they are very concerned about food marketing in schools more than any other type of marketing.

However, the proposed bill would only cover a fraction of the types of marketing that occur in schools right now. Um, it would cover signs and posters and require nutrition standards for those types of marketing but that is actually a very uncommon type of marketing in schools. They are much more frequent marketing such as promotion of healthy foods disguised ad financial support for the school's coupon sponsorship and donated equipment, school fundraisers and etceteras.

So we would like to urge Connecticut to follow the lead of the USDA and other states that have adopted a much more comprehensive definition of food marketing. And include all of the subtle ways that companies try to sell their products especially unhealthy products to children in schools and create brand loyalty. And we thank you for this opportunity.

SENATOR GERRATANA (6TH): And thank you for your testimony. I was reading through it as you of course spoke to us in front of the committee. Are there any questions? If not, thank you so much for coming today and testifying.

JENNIFER HARRIS: Thank you.

SENATOR GERRATANA (6TH): Next on Senate Bill No. 298, is Kathy Flaherty?

KATHY FLAHERTY: Good evening Senator Gerratana.

SENATOR GERRATANA (6TH): Good evening.

KATHY FLAHERTY: Representative Ritter and members of the committee. I'm actually here to testify very quickly on three bills. On 298, we support it because it would increase access to care. House Bill No. 5455 also support, the only thing I'd like to note is that when you're talking about a task force for patient records, there is a designated spot for someone from the Connecticut Trial Lawyers Association but plaintiff's attorneys are not the only people who need access to clients medical records and people apply for social security and other benefits need access to their medical records so I just ask that the committee consider adding someone who represents folks in that capacity.

SENATOR GERRATANA (6TH): And what would you, what would you refer to them as?

KATHY FLAHERTY: I would say either say social security disability, you know advocate or something like that.

SENATOR GERRATANA (6TH): Okay, okay thank you.

KATHY FLAHERTY: So that would be my -- or somebody who represents somebody in social security cases.

And then also Senate Bill No. 299, school based health centers. When I served on the Governor of Sandy Hook Advisory Commission that was the first time I learned about how effective school based health centers are in delivering care. And I think the fact that this committee is raising a bill that would mandate the department to create regulations to create that floor of standards, minimum standards for the school based health centers is a good idea, and we support that. If you have no questions --

SENATOR GERRATANA (6TH): Thank you. Thank you so much for your testimony.

KATHY FLAHERTY: You're welcome, you're very welcome. Thank you.

SENATOR GERRATANA (6TH): Next is Dan Bailey I'm so sorry I cannot read the last name. It might be Bailey, Dan Bailey?

DANIEL BAILEY: Only eight hours in, just think of the Irish cream. Well, good evening and thank you Senator Gerratana, Representative Ritter and the members of the Public Health Committee. Thank you for allowing me a few minutes to speak in favor of raised bills 545, and the establishment of a task force on patient's medical records. I also want to thank you for all the work you put in last year in shepherding this, that was -- we almost got there. But we really do appreciate that. My name is Daniel Bailey, I'm the Region President for BACTES Imaging Solutions, LLC. We're an information service provider in a wholly owned subsidiary of Sharecare, a leading health and wellness engagement platform.

The process of release of information is to securely move medical information from providers to requesters. BACTES operates in 37 states providing this service that mitigates the enormous risk surrounding release of information, while also providing significant economic relief to our hospital, clinic and physician office clients. There is a lot of misinformation surrounding the process of fulfilling medical record requests and the associated complexities. And in many states, the statutes have not been updated for years and therefore do not reflect those complexities. BACTES would also like to volunteer to be part of the task force if possible. We believe we can bring a great deal of prospective to the process and can represent the diversity between the healthcare facilities which adds to the complexities. Thank you again for granting me this opportunity to speak in favor of raised Bill 5455.

SENATOR GERRATANA (6TH): And thank you, too. I did notice that your testimony is not online that I can see. I don't know if you submitted any or?

DANIEL BAILEY: I actually have been traveling the last couple of weeks. I will and I do have it, and I will upload it tonight.

SENATOR GERRATANA (6TH): Good, very good. Thank you so much. Okay

DANIEL BAILEY: Thank you.

SENATOR GERRATANA (6TH): Next is Margaret Guerrera, or Guerret.

MARGARET GUERRERA: Guerrera.

SENATOR GERRATANA (6TH): Guerrera, maybe. Okay, sorry about that. It's the handwriting I can't read. Thank you. This is on Senate Bill No. 289.

MARGARET GUERRERA: Good evening, Senator Gerratana, Representative Ritter and members of the committee. My name is Margaret Guerrera and I am a board member from the Connecticut Society for Respiratory Care. I am also a licensed respiratory therapist. The CTSRC, appreciates this opportunity to submit testimony concerning raised Bill No. 289, AN ACT CONCERNING HEALTHCARE SERVICES. Of particular concern to the CTSRC is Section 9,Section 19A 903B, which concerns allowing trained persons to perform oxygen related patient care activities in a hospital. Senator Looney included this in his testimony earlier this afternoon.

While the CTSRC supports the original intent of the bill which is to allow licensed healthcare providers, certified ultrasound and nuclear medication technologist who have been deemed by the hospital to be competent to perform oxygen related patient care activities in the hospital, we have concerns with the amended language of the bill. Before commenting on the amended language, the CTSRC feels it's important to know that in addition to a sound foundation in cardiopulmonary anatomy and physiology in the physical and chemical sciences, respiratory therapists receive extensive education in the administration and management of oxygen therapy and clearly understand the complications and hazards associated with its use.

The CTSRC has concerns with the amended language proposed in No. 3, which states any person who has been specially trained and determined to be competent to perform the duties by the hospital based on standards set by the appropriate clinical committee of the hospital as this statement relates to No. 3, connecting, disconnecting or adjusting the mask and other oxygen delivery apparatus. And No. 4, adjusting the rate or flow of oxygen consistent with the medical order. The CTSRC is concerned that as written the bill would allow unlicensed personnel to administer and adjust oxygen therapy in any patient care setting.

The CTSRC is committed to safe and high quality care and feel strongly that unlicensed individuals do not have the educational foundation in the sciences including anatomy, physiology in the chemical and physical sciences necessary to administer, adjust or identify malfunctions of oxygen therapy equipment.

Furthermore, unlicensed personnel do not have the educational background to comprehend that oxygen in high concentrations, can be toxic to lung tissue and even in low concentrations can be detrimental to those patients suffering with chronic obstructive pulmonary disease and therefore could not identify an inappropriate or unsafe oxygen order.

The CTSRC understands that patient of varying levels of clinical complexity including those patients receiving oxygen therapy need to be transported to various departments throughout the hospital. It is not our intent to interfere with the daily operation of the hospital. Therefore the CTSRC is not opposed to a properly trained, unlicensed individual connecting and disconnecting oxygen delivery devices for the purpose of patient transport as long as it is done under the supervision of a licensed professional.

The CTSRC --

SENATOR GERRATANA (6TH): Thank you, can you please summarize your testimony, we'd appreciate it.

MARGARET GUERRERA: Yes, basically we are opposed to that language that would deem an unlicensed individual to manipulate oxygen in any way.

SENATOR GERRATANA (6TH): Yes.

MARGARET GUERRERA: Other than transporting.

SENATOR GERRATANA (6TH): We appreciate that too. I know, we had a discussion in our screening committee about it and I said I think this is asking for unlicensed personnel to perform a professional, if you will function so, we appreciate that.

MARGARET GUERRERA: Okay, thank you very much.

SENATOR GERRATANA (6TH): Thank you. Thank you for your testimony. Next is Kristie Barber, followed by Margaret Pointer. You're not Margaret Pointer.

SHANNON VALLEY: I am not.

SENATOR GERRATANA (6TH): Are you Kristie Barber?

SHANNON VALLEY: No, I am actually Shannon Valley [sic] and I'm testifying on behalf of (indiscernible - away from mike).

SENATOR GERRATANA (6TH): Oh, okay, thank you.

SHANNON VALLEY: No problem. So, my name is Shannon Valley and I'm' the program manager from Oval Dental Services Community Health Center, unfortunately, Margaret cannot be here today so I am going to be reading her testimony for her.

So, thank you for this opportunity to submit testimony in references to Senate Bill No. 299. My name is Dr. Margaret Flinter [sic] I'm the Senior Vice President and Clinical Director of the Community Health Center, Inc., a statewide, federally qualified health center headquartered in Middletown Connecticut. I speak against this legislation because it does not appear to advance care, access, safety or quality and would seem to confuse, not clarify the meaning of school based health centers in Connecticut for those constituents which matter most in this discussion. The students, parents, school administrators, teachers, and civic officials. The term school based health center is a description not a regulatory designation. Each school based health center is licensed by the Department of Public Health and is applicable by the Department of Children and Families either directly indirectly, behavioral health services to children. CFS includes operated school based health centers in Connecticut since 1992, when we opened our first health center at the McDonough School in Middletown. And other schools and communities soon began to approach us with interest in developing a school based health center.

We know from firsthand experience the challenges and controversy that many communities faced in the decision to have school based health center in their school and the reluctance on the part of some members of the community to have a school based health center at all, or to have all three of the major primary care services offered. Although our first school based health center is our third medical/dental and behavioral health services, we learned quickly that in some communities there is a need to go slowly and start with only one of the services. The service that their community felt was most important or that they believed there was the greatest need and practically speaking, for which the school had space to accommodate us.

The school based health center is always a guest in the school. Today Community Health Center has 51 licensed school based health centers and provides mobile dental services to many more. Almost all of our school based health centers started with a single service and expanded from there. That initial service might have been dental or medical or behavior health. Nearly 30 of our school based health centers today offer all three services. In time, it's likely that the other schools will offer all three services, but this is a decision for local schools and communities.

The proposed legislation does not clarify but rather confuses the public with the addition of the term expanded school health site. It does not mandate any significant change in service based on this designation, such as requiring and sponsoring a school based health centers or even the expanded health sites to meet a minimum threshold of hours of services or days per week or accessibility during vacations and after hours. Simply put it seems to attempt to solve the problem that does not exist, and in this extremely difficult legislative year, it does not seem to warrant your further time and attention. Thank you.

SENATOR GERRATANA (6TH): And thank you very much. We appreciate that. And thank you for your patience.

SHANNON VALLEY: Thank you for yours.

SENATOR GERRATANA (6TH): Jessie White-Frise, and I think there's just -- followed by Mary Boudreau.

JESSIE WHITE-FRISE: Good evening Senator Gerratana and Representative Ritter and members of the committee. I'm Jessie White-Frise and I am the Executive Director of the Connecticut Association of School Based Health Centers. And I am here to testify today in support of Bill No. 299. The language in this bill simply states that the Department of Public Health shall adopt regulations to establish minimum quality standards rather than, may adopt regulations as is currently codified in Public Act 15-59.

The legislatively mandated school based health center advisory committee, which had representation from state agencies, school based health center organizations, the Connecticut Association of School based health centers, school nursing and the American Academy of Pediatrics worked on the development of these quality standards for 10 months. And, I as co-chair of the committee along with Dr. Robert Dudley from the Commute Health Center who did submit testimony in support of this bill. I can tell you that the standards have already been written and they reflect the hard work, the considerable input, very considerable input, and consensus of all the committee members. And they provide a framework to guide new and existing school based health centers because we do not currently have written standards for school based health centers in Connecticut. The adoption of these standards was recommended in the advisory committee report that was sent to the Department of Public Health or sent by the Department of Public Health rather to this public health and education committee just last week, I believe.

The Department of Public Health provides funding for 96 school based health center sites. Most of these sites provide comprehensive medical and behavioral health services. The standards as described in this bill, will ensure that all sites meet those quality standards, provide a core level of consistent services from site to site. Meet state and federal regulations, meet facility requirements, proper oversight and are sponsored by a licensed entity. Organizations that can meet the criteria of the school based health center definition and the minimum standards can assure parents, schools, and healthcare partners that they are providing the highest quality care possible to children and adolescents that use these services.

And I will just say -- it's not in my testimony but Connecticut is a leader nationally in many aspects of school based healthcare. With the Department of Public Health our school based association is co-leading participation in a national quality initiative that is testing national performance standards for school based health centers. So it only makes sense that Connecticut adopt minimum quality standards for school based health centers to align with the work we re undertaking on the national level.

And so the members of our association support the language of this bill. Many have submitted testimony to you, and urge you to adopt the ill to ensure the highest standards for Connecticut school based health centers. Thank you.

SENATOR GERRATANA (6TH): Thank you Jessie. Just a couple of things, of course I did read the commissioner Department of Public Health his testimony, and I just opened an email that has the report that is -- I don't know if you have seen that report?

JESSIE WHITE-FRISE: Yes.

SENATOR GERRATANA (6TH): I'm not sure if those recommendations in there a report to us on the school based health center advisory committee summary. I, I am scrolling through it. Of course the commissioner says that at this time it's a little bit premature, given that you know there would be the issuance of the report. But now we have the report. So maybe we'll talk a little bit more about that in the future. But I do appreciate your testimony. Take a look at that report and I'll have a discussion with you on it.

JESSIE WHITE-FRISE: I have -- yes, absolutely at another time. Thank you.

SENATOR GERRATANA (6TH): Okay, great. Thank you so much. And as I said before Mary Boudreau, Connecticut Oral Health Initiative -- she had to leave. Okay, is there anyone here who would like to give testimony who hasn't had the opportunity to do so? If not then I will have this hearing closed. Thank you all for attending and your patience. Have a good evening.