00:00 - This afternoon before we begin

00:02 - chairman truly any introductory comment yes thank

00:05 - you chairman Harris good afternoon everyone welcome.

00:08 - We'll see happy faces this afternoon i'm sure.

00:12 - Just to for an overview of the current

00:14 - proposal from the governor for your department.

00:17 - For the upcoming fiscal year of twenty six twenty seven he is proposing a

00:21 - two hundred and sixty point three million dollar

00:24 - a budget

00:26 - an increase of about seven hundred and forty thousand or

00:29 - just point three percent over the current fiscal year

00:32 - with a about forty eight million for the department of

00:34 - drug and alcohol programs an increase of thirty thousand or

00:38 - one percent point one percent over the current fiscal year

00:41 - obviously a lot of things to discuss

00:43 - today

00:44 - related to healthcare and so we will go ahead and get started thank you.

00:49 - Think the gentleman in the middle of the table is our timekeeper.

00:52 - When a light turns green members will have five

00:54 - minutes to ask questions when it turns yellow

00:57 - that means thirty seconds are left and when it turns red

01:00 - that means time has expired we will accept you would wrap up your comments and they

01:05 - would wrap up their questions as well.

01:07 - Before we again

01:09 - we have our test-fired stand up so we can

01:11 - swear everybody.

01:14 - Do you solemnly swear.

01:15 - That the testimony you're about to give us the whole truth so help you god.

01:20 - Okay

01:21 - maybe cd.

01:26 - Yeah.

01:37 - We're going to start.

01:39 - With

01:39 - chairman frankel.

01:42 - Our opening.

01:44 - My bad i'm sorry sir.

01:49 - Do you have

01:50 - do you have opening statements.

01:52 - Okay will

01:53 - commence with the opening statements verse

01:55 - thank you so much

01:57 - and

01:57 - good afternoon chairman Harris chairman Suzie

01:59 - and members of the house appropriations committee

02:02 - thank you for this opportunity to discuss the proposed

02:04 - fiscal year two thousand twenty six twenty seven budget

02:07 - but the department of health

02:09 - i'm joined here by executive deputy secretary Christopher attack.

02:12 - This budget supports the health of Pennsylvania

02:14 - with funding to continue improving outcomes for mothers children and families

02:18 - investing in health research

02:20 - boosting emergency medical services and addressing critical

02:23 - healthcare workforce needs especially in rural areas

02:26 - ensuring this this is a common sense balanced budget for Pennsylvania and.

02:30 - It's been a busy year for us at the department of health

02:33 - last year with investments made by the general assembly

02:36 - we were able to among many other things outlined in my written testimony

02:40 - continue support for regional and maternal health

02:43 - coalitions to improve care for mothers and babies

02:45 - provide equipment and training to support dms professionals

02:49 - as they responded to calls for more than two point two million Pennsylvania ns

02:53 - and coordinate with local county and state partners to efficiently respond

02:58 - to more than twenty emergency situations including the

03:01 - recent fire at lehigh valley health center indexing city

03:04 - and the explosion at Bristol health and rehab center in bucks county none.

03:08 - The proposed twenty six twenty seven budget will allow the department to continue to

03:12 - focus on improvements in many areas of public health

03:15 - and safety

03:16 - including improving maternal and child health with a focus on preventing infant death

03:21 - investing in neurodegenerative research to find new treatments and cures

03:25 - for this generation and for generations to come

03:28 - providing period products in school so students can stay in class and focus on their

03:32 - education and continuing to support dms professionals across the state

03:37 - i look forward to working with all of you

03:39 - to implement this sound budget proposal that enhances

03:41 - the health and well being of all pennsylvanians

03:44 - and i'm happy to answer your questions

03:46 - about first I'll turn things over to my car

03:47 - colleague and friend doctor elliptical Davis Jones.

03:51 - Thank you doctor bogan

03:52 - good afternoon thank you chairman Harris chairman screwy

03:56 - and distinguished members of the house appropriations.

03:59 - Committee for the opportunity to be here today

04:02 - with me as our deputy secretary Kelly premise

04:05 - as secretary i serve at the pleasure of governorship here oh and all pennsylvanians

04:09 - especially those struggling or have a family

04:11 - member or loved one struggling with a substance use

04:14 - or gambling disorder

04:16 - throughout the next few hours i am confident that

04:18 - you will hear about the accomplishments of diet app

04:20 - that we've made throughout the last year and how we're building on the progress made

04:25 - since the beginning of this administration.

04:28 - At dita we believe that Pennsylvania is living with a substance use disorder

04:33 - deserves access to high quality treatment

04:35 - no matter where they live

04:37 - and that treatment and services can be a vital first step

04:41 - on the path to recovery

04:43 - governor shapiro has proposed budget supports that mission.

04:46 - Is blueprint for the next fiscal year recognises

04:49 - our commitment to providing quality services

04:52 - for those that need it the most

04:54 - especially in terms of prevention.

04:56 - Prevention really is the first line of defense

04:59 - in stopping

05:00 - a substance use disorder from

05:02 - developing.

05:03 - Do the governor's proposed budget we have the

05:06 - opportunity to expand our prevention efforts

05:08 - in schools

05:10 - literally meeting children where they are at

05:13 - this would pay dividends in the future and having a healthier

05:17 - safer

05:18 - commonwealth with that please know that i

05:20 - invite all of you to help us achieve our goals

05:23 - whether we're talking about prevention intervention

05:26 - treatment or recovery

05:29 - i look forward to partnering with you in these efforts

05:31 - thank you

05:32 - thank you.

05:33 - Madam chairman frankel.

05:38 - Thank you

05:39 - thank you doctor bogan insula and dr David Jones really appreciative for small

05:43 - thank you for all you do keeping Pennsylvania is

05:46 - safe and healthy as we see all the chaos and fantasy

05:49 - medicine and science coming out of Washington

05:52 - the work you do is more important than ever.

05:55 - I wanted to talk a little bit about.

05:59 - Cannabis and particularly the medical marijuana program and testing

06:02 - in November of last year

06:05 - researchers published an article in the journal clue clinical infectious diseases

06:10 - showing that a Pennsylvania cancer patient.

06:13 - Patients medical marijuana was the source of the infection that killed her.

06:18 - She was a medical marijuana patient with a medical marijuana card

06:23 - by an approved medical marijuana

06:25 - from a licensed medical marijuana dispensary

06:28 - but the cannabis she consume contain cryptococcus neoformans

06:33 - a funk yes that turned out to be deadly

06:35 - as she died.

06:37 - We know the medical marijuana that medical marijuana was responsible because

06:41 - researchers used whole genome sequencing to prove it.

06:46 - My office spoke with the researcher after the article

06:49 - was published

06:50 - in November of last year

06:52 - and what she said.

06:54 - What she said she wants is the same thing i hear

06:58 - that patients want

06:59 - generally and that's a reputable lab operators

07:03 - wanted the department of health

07:04 - oversight for the laboratories that are required to test

07:08 - medical marijuana and ensure that it's free

07:11 - from deadly mold bacteria or heavy metals.

07:14 - What power

07:15 - does the department need to stop another

07:18 - medical marijuana patient

07:19 - from dying for products

07:21 - that they believe are safe.

07:25 - Thank you so much for that question about our program our medical marijuana program

07:30 - and

07:30 - the department of health is tasked with ensuring

07:33 - safety

07:34 - for our program

07:35 - and and

07:36 - and and access

07:38 - to safe medications for

07:40 - patients who need it

07:41 - again this is a medical program so the people who

07:43 - receive these have underlying health conditions cancer

07:47 - seizure disorders

07:48 - and other things

07:49 - and

07:50 - we're certainly aware of the nationwide concern around lab

07:53 - and lab oversight and

07:56 - the issues of thc inflation

07:59 - rate

07:59 - saying that.

08:01 - Products have higher rates

08:02 - of thc than they do

08:04 - i'm passing products that don't meet strict

08:07 - regulatory.

08:08 - Requirements

08:09 - so it's essential that all of our labs that are certified.

08:13 - Allowed the best policies and practices to ensure patient safety

08:17 - and

08:18 - these labs are really the last stop for the product gets

08:21 - to people and so we want to make sure that they're doing their job

08:24 - and

08:25 - they're doing it well

08:26 - i think and we really look forward to talking with you all on what

08:30 - statutory and regulatory

08:32 - options we have out there

08:33 - to.

08:34 - Ensure that we have

08:36 - safest.

08:37 - Products out there

08:38 - and so look forward to working with you on

08:40 - and potential opportunities and we have build it we sent out is

08:44 - out of the house

08:45 - sitting in the senate now

08:46 - haswell thirty three which should help.

08:49 - Think

08:49 - give us a more robust.

08:51 - Testing

08:52 - agenda for the state

08:54 - let me turn to something else

08:56 - that was actually brought to my attention i spoke to

08:59 - Dan Morris about it earlier it came to my attention that that

09:03 - we have a

09:05 - health quality initiative that was federally funded by

09:08 - covert dog colors.

09:11 - To the tune of about twenty five thirty million dollars

09:13 - that would be available to the commonwealth and this was

09:16 - before your tenure

09:17 - obviously as

09:19 - secretary of health

09:21 - and

09:22 - that would.

09:23 - Provide free high quality portable

09:26 - air purifiers to mitigate the spread of coded.

09:29 - Influenza bacteria mold and other airborne pathogens.

09:34 - The program is run through d o h

09:37 - and and

09:38 - and

09:39 - there's money that's there that may may have to be

09:42 - turned back to the federal government of start used

09:45 - and it hasn't been

09:46 - publicized for awhile it seems to me that this is really an opportunity i think

09:51 - still before we have to turn back

09:53 - what looks like about somewhere between twelve and fifty million dollars

09:57 - to be able to kind of reinvigorate it and i think

09:59 - it would be something that members of the general said.

10:02 - Would be

10:03 - very interested in being able to take back to their districts as opportunities

10:08 - to to get these air purifiers out and i

10:11 - was hoping.

10:12 - You guys

10:13 - might

10:14 - might be able to help facilitate that and maybe reinvigorating

10:17 - the

10:18 - the opportunity to publicize this

10:20 - and

10:21 - let me tell you a little bit about that program so as you stated

10:25 - and during the pandemic it became.

10:28 - Really discussed widely that had the filters are a way to reduce

10:31 - and airborne spread of infections and particularly respiratory infections and so

10:37 - on we had

10:38 - cobit funding that we have been using to

10:41 - purchase and distribute i

10:43 - have the filters

10:44 - to

10:45 - particular

10:46 - types of organizations to childcare programs to senior centers

10:50 - libraries to schools

10:52 - and i believe we've distributed about seventeen thousand of those this year on

10:57 - and that program

10:59 - and

11:00 - the funding is going to be ending soon

11:02 - and so we are happy to talk with you afterwards but the program

11:05 - has been out and we did reach out to

11:08 - many many organizations across the state that met our criteria for eligibility

11:12 - at happy to discuss.

11:15 - Remember

11:15 - our

11:16 - numbers would be would be glad to help

11:18 - us

11:18 - get that out that message out and those opportunities out to

11:22 - the organizations in our district so thanks so much appreciated.

11:27 - Share thanks gentlemen and recognizes German gillon.

11:33 - Thank you to testifies for shade being here

11:35 - and I'll keep my questions truncated given the

11:39 - lateness of the appropriations.

11:42 - Hearing so through these last couple

11:44 - weeks and if

11:46 - i were to

11:47 - Google msn Pennsylvania

11:50 - there's another word

11:50 - pops up and that would

11:52 - be crisis

11:53 - secretary would you characterize the dms system in crisis today as well.

12:00 - Gms faces a number of challenges

12:02 - they face financial challenges and reimbursement

12:05 - and

12:06 - you know

12:06 - the current system really

12:08 - offer mms

12:09 - is funded

12:11 - through a variety of sources at the m soft fund as well as

12:15 - billing for services

12:17 - the problem is that readiness isn't real early

12:19 - well funded and they'd spend a lot of their time

12:22 - in reading and responding to things where they don't get reimbursed

12:25 - so for instance there's a house fire and they ambulance

12:27 - sits there waiting to see if anybody needs emergency care

12:31 - and they spend two or three hours there

12:33 - and they don't transport anyone

12:35 - that's not reimbursed

12:36 - and so financially there are some challenges

12:39 - they certainly have a lot of challenges around workforce we've been working a lot on.

12:43 - Addressing workforce issues

12:45 - and providing support and reimbursing people for their training

12:49 - but again lots more work to do on workforce

12:52 - and i think that there are opportunities for all of

12:55 - us to work together on some regulatory reform as well

12:59 - so yes i

13:00 - think we have a lot of work ahead but we are making progress.

13:03 - Are you optimistic that funding help is on the

13:06 - way either a medicare reimbursement insurance

13:09 - reimbursement changes i know there's some products up out there

13:13 - house bill eleven fifty two

13:15 - are you

13:16 - an administrator embracing anything in particular.

13:19 - There have been some changes already as you know

13:22 - the low that

13:23 - reimbursement

13:24 - through medicaid changed

13:26 - over the last year and increased rates

13:28 - are they also started to pay for the first loaded

13:30 - mile not waiting until they got to certain distances

13:33 - and

13:34 - i think there's again more opportunity we have been

13:37 - making sure that the em soft funds are getting out and distributed

13:41 - and we added an extra

13:43 - six million dollars this year and m hsa funds to

13:46 - gms regional councils to get out to agencies for

13:49 - equipment and training

13:51 - but again there's certainly more opportunity to look at the funding mechanisms

13:56 - and for reimbursement lots of opportunity.

13:58 - I was an mp for thirty years i have my own ideas

14:01 - about high turnover in terms of your perspective

14:05 - why are we seeing such high turnover.

14:08 - Turnover amongst gms providers

14:10 - paramedics see empties.

14:12 - Yeah it's a great question

14:14 - again it's it's a stressful job as you know having done it

14:17 - it's twenty four seven it's out in the rain and the sleet and

14:20 - it's not like we have

14:22 - the most

14:22 - amazing weather year round in Pennsylvania so you're out at

14:26 - delivering services so it's a tough job

14:28 - reimbursement and the salaries are relatively low compared to other.

14:33 - Specialties that do that work

14:35 - so again i think there's lots of opportunity i think the other thing is there aren't

14:38 - we know that there are a lot of people who

14:40 - get their empty or their license and then they go onto something else

14:43 - which is great for them right they

14:45 - they get trained they do it for a couple of years and they see it as stepping stone

14:49 - to another

14:50 - he also

14:51 - and.

14:52 - I think we have to figure out how we make

14:54 - sure that there are ways to rise in the field

14:58 - and so i'm happy to talk with you about

15:00 - what you think we can do to improve that

15:02 - you're right

15:03 - people do move from the mts of less stressful jobs i made the mistake of going into

15:08 - the legislature saying it would be less stressful.

15:11 - They don't call you at two in the morning to get out of bed do they.

15:15 - And just finally

15:17 - in terms of recruitment

15:18 - have you found any particular approach to be more

15:21 - efficacious than others drawing people into the field.

15:24 - You know we've been working a lot

15:26 - with our

15:27 - regional councils on training and opportunities so we have the summer camps where

15:31 - we've gotten high school students interested.

15:35 - When when i go around the state and i talked to people in all kinds of fields and i

15:38 - say like what got you to go to a long term care facility

15:40 - and work in a long-term care facility what got you to

15:44 - going to m s.

15:45 - It's often their experiences as a young person that

15:48 - drives their interests later so i think again making sure

15:52 - that people know about the field and the opportunities.

15:55 - I know that for instance we are at the farm show with an ambulance last year

15:59 - and this

16:00 - people like really were interested in walking in sing it was like

16:03 - so how do we make sure that we provide experiences

16:05 - for our young people know that these are opportunities

16:09 - for them for that work

16:10 - i think it's.

16:11 - Harder

16:12 - as people age

16:14 - to make that intro escrow

16:16 - taken for taking those

16:17 - steps secretary thank you mr chairman.

16:21 - Sure thanks gentlemen and recognizes German Williams.

16:24 - Mrs German thank you and doctor Jones

16:28 - doctor bogan as well as your staff thank you for

16:31 - the critical work that you do.

16:33 - Let me begin by asking you these questions the recent drug surveillance report.

16:38 - Actually showed an increase in overdose deaths

16:41 - involving stimulants.

16:44 - Can you talk about the factors that you think are contributing to that rise

16:48 - and then what strategies

16:50 - might be able to address it.

16:55 - Thank you for the question.

16:57 - I'll start by saying that we know

17:00 - as it relates to our drug supply and what people are being admitted to treatment for.

17:06 - Stimulant is one of the top top three right we're talking about

17:10 - alcohol

17:12 - although by opioid and then also stimulants and so what we're doing is ensuring that

17:17 - across the commonwealth that people have access to the care that they need

17:22 - and we're ensuring that underrepresented.

17:26 - Communities across the commonwealth have

17:28 - that

17:29 - they have access as well and so some of the things that we've done is

17:32 - expanding mobile units across the commonwealth.

17:36 - For this past fiscal year we were able to bring

17:39 - on two additional units so now we have four

17:41 - so again.

17:43 - Making sure that people have access to key where when and where they needed in

17:47 - addition to that we've also expanded telehealth options

17:51 - across the commonwealth we have a telehealth

17:53 - only license here in the commonwealth now.

17:56 - Last year i think we were at one or two we now have

18:00 - five telehealth only

18:02 - providers and again

18:03 - that's an opportunity to expand

18:06 - access as for those that may not be able to go into a physical location

18:10 - so

18:11 - again ensuring that people when they need access to the care

18:15 - whether it be for an opioid use disorder or stimulants

18:19 - that we have services available

18:21 - and then once they leave formal treatment we want to make sure that we have recovery

18:25 - support services in places as well

18:28 - we need recovery support services to help them

18:31 - along their journey

18:32 - and so that some of the work that's happening within our department

18:36 - dr b do you have anything else that.

18:39 - I think you

18:40 - i think she covered that yet.

18:42 - I appreciate their response.

18:44 - Secondarily we are also seeing an increase in

18:48 - emerging intoxicating substances including

18:51 - new synthetic opioids

18:53 - synthetic crude and products

18:54 - synthetic cannabinoids

18:56 - you talk about the steps the department is taking to

18:59 - monitor and respond to those substances

19:02 - then secondarily

19:04 - what actions do you think this legislature might be able

19:07 - to consider to help

19:08 - ensure they're not reaching consumers

19:11 - particularly when they're being sold through

19:13 - storefront retailers.

19:16 - Let me start with this.

19:18 - I

19:19 - appreciate that a question about these unregulated intoxicants as we kind of

19:24 - lump them all together

19:25 - and

19:26 - and

19:26 - they are a growing problem across the state issue

19:30 - and identified

19:31 - and

19:32 - we and we have

19:34 - regulation and.

19:36 - Enforcement

19:37 - challenges around them

19:38 - because they come from a variety of things some are

19:42 - plant based

19:43 - and

19:43 - sold in as you say convenience stores

19:46 - the department of health role really is on tracking

19:49 - and surveillance and education

19:52 - and so we have been working

19:53 - diligently trying to make sure we provide education

19:56 - and i think part of the challenge is

19:58 - that we are run the medical marijuana program and that is

20:01 - regulated and overseen and products are tested and people confuse those

20:06 - with the unregulated market

20:08 - and that has been a challenge so when someone shows up in an emergency department

20:12 - and we're not necessarily knowing

20:14 - whether they

20:15 - are using an unregulated product or what

20:17 - and and then tracking them has been very

20:19 - department of health really is working on

20:21 - tracking and surveillance

20:23 - and a lot around education and we're also working together as an administration so

20:28 - we have a committee we are meeting regularly to talk about

20:31 - how do we as a administration really respond to this

20:34 - more broadly and i'm

20:36 - sure dr

20:37 - Jones will

20:37 - add to that and I'll just pick up from right there and

20:40 - the committee that doctor bogan is referencing is our inter

20:44 - intra agency substance use response team

20:47 - and we are convening agencies again across the shapiro

20:51 - administration to examine intoxicating him

20:55 - derivatives and other products sold at gas stations and throughout Pennsylvania

20:59 - and we do recognize that these

21:01 - products are totally

21:03 - unregulated at this point under the current law and we're making some serious.

21:08 - Inquiries about what we might do

21:10 - in the future and so we've been meeting over

21:12 - the past i would say maybe six to eight weeks.

21:15 - Taking a deep dive looking at what's out there

21:17 - and what we may be doing in the future and so

21:21 - we want to make sure that when we move forward

21:23 - that there is public awareness and that

21:26 - there's transparency about these products that are

21:29 - in

21:29 - convenience stores across the commonwealth

21:32 - so

21:32 - it's a work in progress

21:34 - can i add one more thing you know the the hemp loophole.

21:37 - That's been closed and hemp products doesn't go in into effect this fall

21:41 - but there's a whole lot of other products that don't fall under that

21:45 - hemp

21:45 - loophole as well that are

21:47 - another class of unregulated so again it's a very.

21:50 - Broad topic that we need to really

21:53 - work with you all on how we

21:55 - rein in.

21:56 - Access to these products

21:58 - and i appreciate your response as much time as is bar

22:01 - mitzvah German.

22:03 - Sure thanks gentlemen

22:04 - and recognizes German hopefully.

22:07 - Thank you

22:08 - and.

22:09 - Because the question we

22:11 - were less before doctor Lucy

22:13 - Jones

22:13 - and the

22:15 - Adidas

22:16 - Adidas has oversight over recovery houses and

22:19 - making sure that you're complying with federal state and local laws

22:23 - and

22:23 - what steps

22:24 - is the depp take right now to ensure that Rick re

22:27 - houses and we worked on legislation a few years ago

22:30 - regarding recovery houses what steps do they take right now

22:32 - to ensure that ders compliance with those local ordinances

22:36 - yeah

22:37 - but i will say as you all know diet abs

22:40 - recovery housing let licensure program is just

22:42 - one more tool in our tool box to ensure that

22:45 - all pennsylvanians across the common wealth have access to

22:49 - supported housing

22:51 - recovery housing is

22:52 - not treatment we just want to

22:54 - make sure that we call that out

22:55 - but it is a house where they receive mutual support.

23:00 - From their substance use.

23:02 - Disorder

23:04 - the department license we currently license

23:07 - recovery houses and.

23:09 - We license recovery houses that are open to receiving state and federal funding

23:15 - when you talk about occupancy and local ordinances we do not have any skin in the

23:22 - game from that perspective but we do require.

23:26 - Rekha

23:27 - recover three houses to attest

23:30 - to the fact that they are in compliance with local

23:34 - laws and ordinances and so we license

23:38 - and we

23:40 - license against our

23:41 - regulations.

23:44 - So.

23:45 - Pursuant to the

23:46 - current law

23:47 - does state that

23:48 - the dep

23:49 - must.

23:50 - Make sure that his recovery houses are in compliant with federal state and local

23:54 - ordinances and we do that through an attestation process.

23:59 - We also work with local

24:00 - communities when they have issues and and present them to us

24:05 - for example whether if the occupancy or zoning

24:07 - if they would come to us about that attestation

24:10 - would certainly work with them

24:11 - and provide them with what

24:13 - they need we believe that we understand substance use disorders and what people need

24:18 - in terms of treatment and support

24:20 - and that's what we focus on to ensure safety.

24:24 - Or since financials

24:26 - and their rights

24:27 - are protected in a recovery house

24:30 - and we allow the experts which

24:32 - the local

24:33 - municipalities and authorities

24:35 - to focus on the implementation and monitoring of things such as zoning and occupancy.

24:41 - Just want to make sure that when people are living in these facilities

24:44 - that that they're being compliant they were

24:46 - overseeing that local compliance because a lot

24:48 - of that local content comes down to fire safety

24:50 - other safety i know there's been an issue

24:52 - and we're

24:53 - so

24:54 - just but just

24:55 - because i have one more round when we're.

24:57 - Out going to add something else but I'll let you go

24:59 - okay.

25:00 - It is an ongoing disaster i just wanted

25:03 - to shed some light on that why it's why it's important

25:05 - because at the end of the day you guys are that that

25:07 - that that oversight.

25:09 - The one thing i did want to touch on it is i'm hearing

25:11 - from

25:12 - of providers.

25:13 - That

25:14 - payments may be delayed

25:16 - and we talked a little bit about

25:17 - every hearing we have we talk about worker shortages

25:20 - provide shortages and incoming from a rural county

25:23 - that is very real

25:24 - and

25:25 - one of the reasons is his pay and and

25:28 - some of the things that go along with that

25:30 - but.

25:31 - When we look at

25:33 - things being delayed

25:34 - due to issues

25:35 - with the depp revising

25:36 - and

25:37 - executing the funding agreements

25:39 - with single county

25:40 - sch

25:40 - what kind of authorities

25:42 - what does the department doing to expedite this process to ensure that the money

25:45 - flows to these counties in a timely manner because they

25:48 - generally do not have reserve funds to back this up.

25:51 - Absolutely and i will just say that the delays in processing some of our grand

25:56 - agreement are the result of multiple factors

25:58 - including

26:00 - the commonwealth budget impasse along with the federal government

26:04 - shut down

26:05 - but what i can assure you is that we are working

26:07 - diligently to get those contracts out the door

26:10 - what i will say we are

26:12 - ensuring that and as of today i think.

26:17 - What was the number Kelly do you recall the number that we had.

26:21 - Or thirty waiting.

26:22 - At the comfortable there are three years you're

26:24 - thirty right now at the comptroller's ready to be

26:27 - sent to a single county authorities

26:30 - and so what i will say we've worked

26:32 - really hard to get those done

26:34 - we recognize that

26:36 - se a a's do need

26:39 - their contracts and that

26:41 - in order to bail us they have to have an

26:44 - executed a grand agreement so

26:46 - we are

26:48 - continuing to get those out the door and we're hoping within the next couple of weeks

26:52 - those

26:53 - essays will have at their Grant agreements

26:56 - yeah so that's

26:56 - the other

26:57 - the

26:57 - question is is with the.

27:00 - Executing this five year agreement

27:02 - and that interruption.

27:04 - That is result in interruption of cash flow at the end of the calendar year

27:08 - and some providers are are fearful that they may not be

27:12 - reimbursed for services between July and December of two thousand and twenty five

27:16 - if the invoice wasn't submit

27:17 - by the end of December

27:19 - what would you say to providers how are we going

27:21 - to resolve that because we have to have these

27:23 - providers reimbursed for the services they have.

27:26 - They have already.

27:29 - Provided

27:29 - our our goal is to ensure that the se a's

27:32 - have their funding that are that is stated in

27:35 - in their Grant agreement

27:37 - and as as long as the provider

27:39 - as long as the su hate a has their Grant agreement and they invoice us or

27:44 - the services delivered

27:46 - and providers

27:48 - from my understanding should be able to be reimbursed

27:51 - what we'll do is we can go back in and really give you a more comprehensive response

27:57 - to your question but what i will say those contracts.

28:01 - As a contract but Grant agreements are underway and we do have the funding available

28:07 - to support our single county authorities

28:10 - and as you know those single county authorities

28:13 - contract with our provider networks

28:15 - across the commonwealth

28:17 - and they should be a to provide those

28:19 - reimbursements

28:20 - who are provider agencies thank you and

28:22 - look forward to working with you on on that and many other issues

28:26 - thank you for your time here today

28:27 - thank you.

28:29 - Sure thanks gentlemen and recognizes representative mais.

28:33 - Thank you chair

28:34 - happy women's history month welcome doctor bogan and dr David Jones

28:38 - for being here thank you for being here

28:42 - and thank you for your continued leadership as we work

28:45 - to end a public health crisis of black maternal health and return health across the

28:50 - commonwealth as co-chair the Pennsylvania

28:51 - black maternal health caucus we want to invite.

28:55 - You and your team to black maternal health week at the capitol and everyone who can

29:00 - hear us

29:01 - who is watching we invite you to the capitol April thirteenth and fourteenth

29:05 - as we celebrate once again

29:07 - black maternal health week.

29:10 - I want to talk to you about the maternal mortality

29:13 - review committee report that is now required to be.

29:17 - Released to the public every year

29:20 - which is showing us the trends that are impacting

29:25 - our moms across this commonwealth.

29:28 - We know we continue to fail face.

29:30 - Racial disparities

29:32 - in maternal mortality and

29:34 - maternal morbidity

29:35 - and that across the board maternal deaths are preventable

29:40 - so in this most recent report

29:42 - ninety eight percent

29:43 - of maternal deaths

29:45 - were preventable

29:46 - in the previous year's report it was ninety two per percent

29:50 - were preventable.

29:52 - So doctor bogan

29:53 - i just want to ask you.

29:56 - As much as we are continuing to invest here in our

29:58 - commonwealth we have had the greatest investments

30:02 - in maternal health and black maternal health in our state budget.

30:06 - What's your assessment of what we can continue to do from here ear

30:10 - as we face a myriad of challenging and complex systemic issues that are contributing

30:16 - to the black maternal mortality rate and maternal mortality rate across

30:21 - the board we love your insights and we appreciate

30:24 - again all the interventions that you've already done

30:28 - that we've done together

30:30 - what more can we do.

30:33 - I i appreciate

30:34 - that question a lot

30:36 - and

30:36 - as you said

30:37 - you all the general assembly and the governor have really for the first time

30:41 - since this administration really put money to the issue that you're talking about

30:46 - and

30:46 - and that money is really i think we're just beginning to start to see the

30:51 - the.

30:52 - Impact of that work

30:54 - so that work has been

30:55 - funding regional maternal health

30:58 - coalitions

30:59 - that are identifying in each of their regions

31:01 - what is a pressing issue and what really

31:03 - how do we really implement

31:05 - the recommendations coming out of the maternal mortality review committee

31:09 - and as you know we've been working on a maternal

31:11 - health strategic plan with all of our ces for agencies

31:15 - and

31:15 - again

31:16 - we have seen this money go out the door so we are now seeing eye doulas that had been

31:21 - trained and are out in the community working

31:23 - we are seeing people being screened for hypertension

31:26 - during pregnancy and after pregnancy which is where we see a lot of the problems

31:31 - and

31:32 - we are seeing much greater rates of mental health screening

31:35 - amongst

31:36 - our providers

31:37 - and all of those

31:38 - things and and and really addressing screening for

31:42 - mental behavioral health and substance use because we know

31:45 - that a lot of the preventable deaths relate to mental health and substance use

31:48 - disorder and we really want to make sure

31:50 - that people are getting screened and referred

31:52 - to services and getting the services they need

31:55 - and that's why it's important that all the agencies are doing this work it's not

31:58 - one agency it's really across all of us

32:01 - so i think again the money has been going out the door for the last two years

32:05 - but it's going to take time to see

32:07 - the impact on the

32:08 - the

32:09 - mortality rate but we

32:12 - are hopefully identifying people earlier

32:14 - and making sure they have the services they need

32:17 - i think this is

32:18 - slow and steady work and we need to continue what we're doing and not let up right

32:23 - we need to continue to make sure every

32:25 - person receives early prenatal care

32:27 - gets the prenatal care they need and we have challenges in that case as you know

32:31 - we have large swaths of the state

32:34 - that where that is a real challenge

32:36 - so we have a lot of work ahead of us

32:38 - and i think our strategic plan that we're all working on together

32:41 - will help guide our pathway but we need to keep that

32:44 - that gas pedal down and really making sure we're not letting up

32:48 - and i know.

32:49 - That drug and alcohol programs has also been working on

32:52 - maternal health issues

32:54 - they fund that the really great.

32:56 - Program other NATO quality collaborate as the Diego u c

32:59 - which has been doing great work with all of our birthing

33:03 - facilities across the state so

33:04 - i won't leave a minute for doctor Davis Jones to add if she would like

33:07 - absolutely and I'll just say that you know our department is committed to ensuring

33:12 - that we have pregnancy support services across the commonwealth

33:15 - a right now

33:16 - for this

33:18 - year's budget

33:19 - upcoming budget we have over eight million dollars slated to

33:24 - support pregnant women women with children

33:26 - and we will continue to expand services where where necessary

33:31 - while our minimum is twenty percent of our federal budget has to be

33:36 - sort of dedicated to that

33:37 - particular area.

33:39 - We are making sure that we are collaborating

33:42 - whether it be in regards to plans of safe care

33:46 - you know the strategic maternal health plan

33:48 - along with supporting programs like baby the baby love program at Hamilton health

33:53 - we are are

33:55 - continuing to do that work so

33:57 - just know as dr b just stated

34:00 - do

34:01 - you know the impact it's going to take a little bit of time

34:04 - but we have the resources and supports available

34:07 - and.

34:08 - We will be tracking and evaluating the effectiveness of art interventions

34:13 - think he will chair could i

34:14 - have one more minute.

34:16 - Thank you so much

34:17 - i appreciate that and i want to turn to the Pennsylvania mommy bus which is let the

34:22 - legislative package that is groundbreaking in our

34:25 - vision of reversing the disturbing trends of maternal mortality and morbidity

34:30 - that you've address some of the

34:32 - ways that we can continue to intervene

34:34 - i do want to ask specifically a specific question about two medical conditions i

34:39 - don't think are being uplifted enough

34:41 - and my one bill house bill one two three four that addresses.

34:45 - The coverage medicaid coverage for blood pressure monitors to address preeclampsia

34:50 - or high blood pressure

34:52 - how important that is

34:54 - to due

34:55 - to moms and those are pregnant are commonwealth

34:58 - to make sure we're tracking their blood pressure throughout

35:01 - pregnancy during labor and in the postpartum period also want to ask you about

35:06 - the impact of

35:07 - cardiovascular or heart health

35:10 - and how does that impact the maternal mortality and

35:13 - morbidity so preeclampsia and ca cardiovascular health.

35:17 - What what are you seeing

35:19 - in terms of.

35:20 - How how is that impacting

35:23 - moms across the commonwealth those who are about to give birth

35:26 - those who are in that postpartum period.

35:29 - Yeah those are

35:30 - two really important

35:32 - contributors to both

35:33 - and.

35:34 - Morbidity d and mortality so morbidity being more illness and postpartum and so

35:39 - we do

35:40 - have

35:41 - a number of programs

35:42 - through the funding that we've already initiated

35:45 - to address

35:46 - blood pressure monitoring so

35:47 - in the wic program and one of our areas they've

35:50 - screened over one thousand women for blood pressure

35:53 - and if they're elevated they've been giving them

35:55 - a blood pressure cuff and asking them to follow up

35:58 - and giving them lots of education and i think about ten percent of the

36:01 - women they've screened actually I've had hype high

36:04 - blood pressure and they've referred them on and

36:05 - provided education so linking them to services

36:08 - is really important

36:09 - I'll also point out that it's not just blood pressure

36:11 - during pregnancy which is also very important

36:14 - but it turns out that people can get postpartum

36:16 - hypertension that didn't even have it during pregnancy

36:19 - so it's important to monitor after

36:21 - and there are a number of programs that are happening

36:23 - in pediatric offices where they're screening

36:25 - mothers who come in because we know

36:27 - that

36:27 - after the birth of a child people that tend to take their baby to pediatric care but

36:31 - don't necessarily get their own care

36:33 - and so some of the pediatric practices are screening

36:36 - mothers as well for postpartum hypertension

36:38 - so i think we need to as a group really make sure we understand.

36:42 - That the the breath of this condition the ways we can screen

36:46 - and we need to make sure that mothers have the education that they know what the

36:49 - signs of hypertension and cardiovascular disease look like.

36:53 - So that they can

36:54 - see care when they're having some items

36:56 - so thank you the Pennsylvania black maternal health caucus we will be unrelenting

37:01 - with you and your leadership roles to address black maternal mortality and morbidity

37:05 - all across the commonwealth thank you chair

37:07 - we look forward to working with you

37:08 - thank you.

37:10 - Share things generally representative bro.

37:13 - Thank you chairman

37:14 - and

37:15 - dr Davis.

37:17 - I would like to

37:20 - talk to you about the opioid settlement funds

37:23 - and

37:24 - i would like to know if you've ventured into any

37:28 - multi year contracts that go beyond the current fiscal full year

37:34 - to

37:35 - provide those

37:36 - that funding.

37:38 - Multi

37:39 - year yes.

37:41 - I do

37:42 - yes absolutely we have let me just get through my section of mine.

37:56 - So

37:57 - to answer your question

37:58 - yes we have.

38:01 - And do those contracts contain clauses that voids the contract in the event dollars

38:06 - are not appropriated in two thousand twenty six twenty seven

38:10 - or future planning years.

38:15 - That's a good question.

38:17 - We we definitely have classes that talk about.

38:21 - Being able to separate.

38:23 - From

38:24 - whoever the grantee is

38:26 - but in terms of

38:28 - appropriating if

38:29 - funds wouldn't be spent we would

38:31 - have to reallocate them.

38:33 - From that provider to another provider

38:36 - okay good.

38:37 - So in November this chamber nearly passed unanimously.

38:44 - House bill fifteen twenty eight

38:46 - to establish the grand family assistance program

38:50 - of which i was proud to be one of the co primes on

38:53 - with both of the chair

38:56 - persons of the aging committee

38:58 - and this is legislation that is so vital

39:01 - to our grandparents that are raising their grandchild aldrin in our communities

39:06 - and it's my understanding that your department had concerns with utilizing opioid

39:11 - settlement funding for this legislation

39:13 - because it was already committed.

39:16 - For the out years.

39:19 - Is this correct.

39:22 - We do have commitment

39:24 - for opioid settlement funds and just to levels that

39:28 - when you think about the opioid settlements we know that

39:31 - eighty five percent goes to.

39:35 - Counties and litigating subdivisions fifteen percent

39:38 - comes to the commonwealth and if appropriated by the

39:41 - general assembly

39:43 - then

39:44 - eat out will

39:45 - get those funds and so we have to plan for those buttons when we receive them

39:50 - so therefore we've had several

39:52 - initiatives.

39:54 - Aramark

39:55 - afford to to receive opioid settlement funds

39:58 - and so at the time that we were looking at the the

40:01 - the legislation.

40:03 - Our thoughts were that

40:05 - that's where those funds are committed and

40:07 - we were moving forward with those

40:09 - initiatives and so

40:10 - there's always opportunity we have said.

40:13 - Loud and clear that.

40:15 - Organizations and individuals can meet with

40:19 - all of the counties that

40:21 - are.

40:23 - That do have a process in place to.

40:27 - Read

40:27 - excuse me that have

40:28 - a process in place to actually talk about the

40:31 - different

40:32 - kinds of initiatives that they want to fund them

40:34 - some

40:35 - counties do proposals they put out requests for proposals some of them have

40:41 - working committee yes and i'm i'm

40:44 - but respectfully this this problem is prevailing across the state

40:47 - and again it passed almost unanimously so

40:50 - it's obvious it's a problem for the state

40:53 - so is this legislation something you would

40:56 - reconsider.

40:57 - We will definitely take it back to our department to have

41:00 - some discussions i think we're always going to be open

41:04 - to have those discussions

41:06 - most certainly

41:07 - okay we would greatly appreciate that

41:10 - thank you so much definitely.

41:18 - The gentle lady representative curry.

41:21 - Thank you chairman.

41:22 - Hello and good afternoon

41:24 - happy women's history month

41:26 - and i'm here to talk about

41:29 - the devastating impact that maternal

41:32 - care deserts have in the commonwealth right now.

41:36 - I currently have have a bill that we're working on in the mom nimbus

41:41 - two point oh house bill for thirty two

41:44 - which addresses maternal health deserts through maternal care access zones

41:49 - and.

41:50 - Twenty three of Pennsylvania's sixty seven counties

41:54 - do not have a hospital that provides labor and delivery server ss

41:58 - in all twenty three of them

42:01 - are rural counties.

42:03 - For families in these areas the average distance

42:06 - to the nearest hospital providing these services

42:09 - is about twenty seven miles

42:11 - and unfortunately now i can say that in my own county

42:15 - Delaware county.

42:17 - As maternity units continue to close or consolidate timely access to care becomes

42:23 - even more critical to healthy pregnancies

42:26 - and births

42:27 - what is the department's plan to address these maternal care deserts

42:31 - and how are you working to ensure that expectant mothers

42:35 - in these communities can access the care

42:37 - they they need close to home

42:39 - and i have one more question so

42:41 - can you answer that one first thanks

42:43 - though i try to keep it short okay thank you for raising this important issue

42:47 - that certainly is worrying for all of us right

42:50 - and.

42:51 - You gave lots of us statistics about the challenges facing.

42:55 - People getting care across

42:57 - particularly in rural Pennsylvania

42:59 - and the department of health

43:01 - and really

43:02 - as it

43:03 - is not just the department of health issue right this is a statewide issue that we

43:07 - all need to address together i think there are challenges in workforce.

43:12 - That are driving some of this

43:14 - there's also.

43:15 - Challenges in maintaining the cost of

43:18 - maternity unit so

43:19 - we need to think about how we fund these because.

43:23 - You know to run a maternity unit the

43:25 - requirements are that you have to have twenty four seven care

43:27 - you need to have an operating room available you need to have that available to be

43:31 - staffed you need amnesty Asia care

43:33 - you need to keep your staff trained right we want well trained

43:37 - maternity units

43:38 - so the way we currently fund that is challenging

43:41 - and and how

43:43 - you make it's again it's kind of an issue of readiness and so i think we need to

43:46 - think strategically how do we make sure that we

43:49 - fund those that we have the workforce available to

43:52 - to do that

43:53 - and you know we have

43:55 - a shortage

43:56 - of.

43:57 - Healthcare providers and nurses

43:59 - so i think again i

44:01 - i welcome all discussion on this it is addressed and i think

44:04 - part of our

44:05 - maternal health strategic plan addresses this and i think

44:08 - the rural health transformation plan funding

44:10 - maternal health is certainly one of the goals of

44:14 - that work as well so i think

44:15 - we have opportunities to use that funding there

44:19 - are definitely opportunities and i think

44:21 - we've talked about mobile carrier units

44:23 - and bands i think

44:25 - representative brown has often talked about her area

44:28 - where

44:29 - they have to go into other states to have babies our neighboring state

44:33 - and the mobile units are critical i know they're

44:36 - expensive but we need to start thinking about it because

44:38 - the reports that we're getting are that women

44:41 - are having babies and ambulances

44:43 - and then the care after that is not there

44:46 - and so we talk about the black maternal health

44:50 - disparities but we're talking about one maternal care

44:54 - health at this point

44:55 - because we don't want to continue to see moms

44:58 - die

44:59 - and this is what's happening and we don't have that care

45:03 - the other question that i wanted to

45:05 - hurry

45:06 - yeah sure

45:07 - you wanted to add something to that conversation sure I'll be quick i promise

45:11 - and

45:12 - in in addition to it

45:13 - secretary bogan said we've also been working

45:16 - on this issue and

45:18 - have done an environmental scan

45:20 - with six different counties two of which are healthcare maternal healthcare deserts

45:24 - and the others have limited access

45:26 - and worked with them in the local counties to.

45:30 - Basically assess the sister's situation

45:32 - and work toward.

45:34 - A solution in interventions which we plan to.

45:38 - Work with

45:38 - the department of health the department of human services and one map

45:42 - together on that.

45:44 - So we're looking for some

45:45 - additional solutions and says

45:46 - so they will be coming forth

45:48 - soon.

45:49 - Thank you very much for that and then hospital closures like Crozier health

45:53 - have left entire communities with fewer

45:56 - local healthcare options

45:58 - when a patient is transported to a hospital by e m s

46:01 - the patient may have preference of which ask but ought to go to

46:05 - now in my area they don't really have that press

46:07 - preference

46:08 - but how does the department monitor these patterns

46:11 - and ensure that hospitals receive adequate support

46:14 - and resources and

46:16 - i know we've been on calls

46:17 - about this and

46:19 - how's the department monitoring it.

46:22 - I

46:23 - am not trait can you clarify your question is

46:25 - specifically about

46:26 - running out of time yeah no chairman

46:28 - so so basically

46:30 - when somebody gets into an ambulance and they're

46:33 - like take me to this hospital versus the hospital

46:36 - so.

46:38 - Yeah mess

46:39 - generally takes

46:40 - people to the closest hospital that can provide the service

46:43 - that they need

46:44 - and

46:45 - so

46:46 - that's the general rule you get into an ambulance you go to the nearest hospital

46:50 - people can ask for a preference to go to a particular hospital for instance

46:54 - if that's where they get all their care and they know the doctors there

46:58 - or they recently had surgery at that hospital so they can ask

47:01 - but the vms.

47:03 - Providers can say look that's not safe we need to take you to the nearest hospital

47:08 - well i

47:08 - am a doctor nugget

47:09 - yeah thank you doctor bogan cause i'm getting the i but

47:12 - thanks

47:13 - to both of the departments for the great work that you're doing

47:16 - to help the caucus and we appreciate all your work

47:19 - thank you pyramid.

47:24 - Representative Kale.

47:25 - Thank you mr chairman i'm going to continue on this line of questioning so we can get

47:30 - more discussion before i do doctor bogan i just wanted to say i love your earrings.

47:36 - I don't know if it's the color or what it is but

47:39 - just wanted to give a compliment first starting certain thank you for the coast

47:42 - this is from costa rica

47:44 - artists i bought it at a little shop about twenty years ago yes.

47:49 - They're are very nice and i might have to get my wife a pair of them here but

47:54 - i wanted to talk a little bit about Willow healthcare

47:56 - in my district age and is looking to

48:01 - i'm not sure exactly what the technical term is affiliate merge and buy however it

48:07 - works with heritage valley system and we're very excited

48:09 - about this prospect because there was real concern

48:12 - that that hospital

48:13 - it was was not going to be able to function long term

48:17 - because of their financial situation with age and coming in.

48:20 - Where it works cited that that that staple of the community is going to be there

48:25 - for for years to come but unfortunately

48:28 - for far too many community he's within our commonwealth

48:30 - in particular in the northern tier of the commonwealth

48:34 - that is not the case so i wanted to ask a couple of questions

48:37 - with that backdrop in mind the first is

48:40 - my understanding is that the administration is looking to

48:45 - his undertaken effort to

48:47 - basically change the regulations within the community

48:50 - hospital community.

48:52 - Can you give an update on how that process is going and if you are looking in and

48:57 - considering during that process the impacts it could have on rural hospitals and

49:01 - keeping them open.

49:03 - Absolutely so

49:05 - do

49:06 - the hospital regulations in Pennsylvania are currently about four decades old

49:11 - and they're very old

49:13 - and

49:13 - my understanding long before i was at the department

49:16 - back before

49:18 - twenty twenty they were being worked on

49:20 - they

49:21 - kind of stalled during

49:22 - the twenty twenty twenty the

49:24 - two period

49:25 - and when we came here we really picked that effort up

49:28 - so because these regulations are so old and quite extensive

49:33 - and they do need to really have a close look so we've been working really closely

49:37 - with stakeholder groups we've been doing a lot of stakeholder engagement and to

49:42 - understand what the needs are and our do rafting

49:44 - and updated hospital regulations

49:47 - i think it's really important we're trying to make sure that the regulations have as

49:50 - much flexibility built into them as possible

49:53 - because i think

49:55 - you and i both know that healthcare today is not what it's going to be two years from

49:59 - now six months from now right there are changes

50:01 - that the rapidity with which it's happening

50:04 - so our team's been working really hard with

50:06 - stakeholders with hap and other organizations on those

50:10 - and

50:11 - we continue that work and we're hoping to have

50:14 - those out his proposed and hopefully in the next

50:17 - by next year so we are working on those

50:20 - but it is really about stakeholder engagement

50:22 - but meanwhile while that's happening i think we

50:24 - have been working really hard on making sure we

50:27 - provide flexibilities where we can write if something's written into the act

50:31 - that's the law we can't change that

50:33 - but we can make

50:35 - flexibilities if we can and we have an exception process that we've used

50:38 - to try to make flexibility so we've put out a number of guidance documents last year

50:43 - i think have to

50:45 - the burden on hospitals

50:46 - around attestations for equipment

50:49 - around

50:49 - physician coverage and other things so we are trying to

50:52 - do the best we can within the regulatory framework we have

50:56 - to be responsive

50:57 - and to be flexible and we

50:59 - have been working with

51:00 - happ and

51:01 - the rural hospitals and

51:03 - I've been out to about twelve or thirteen brawl hospitals over the last couple of

51:06 - years talking to their leadership on

51:08 - what are the things we can do right now

51:10 - to reduce the burden but but again i think the ultimate

51:13 - issue is that we need to get those hospital regulations.

51:17 - Out there for

51:18 - major changes

51:19 - are

51:20 - more particular question Bradford county the regional medical center there

51:24 - announced that it will was in fact closing but there

51:27 - was a plan put forward to have a continuity of of services going

51:31 - forward and

51:33 - my understanding is that they are waiting on an

51:35 - approval from your department could you give an update

51:38 - on that situation.

51:40 - And

51:41 - i don't know that they are waiting on anything from us i'm happy to have a discussion

51:45 - offline to talk to you about that

51:47 - and i'm not aware of anything that they are waiting

51:50 - for an asset this at this moment but again i

51:53 - would be happy to talk with you afterwards about that particular hospital

51:56 - and that's a more general matter that this issue

51:59 - with rural hosp atolls

52:01 - across the

52:02 - commonwealth hospital shutting down

52:03 - this has been hot for some time and certainly since

52:06 - this administration has come in

52:08 - what are some of the steps the administration has taken thus far

52:12 - and what can we be doing as a legislature to help improve this situation

52:17 - at yes our rural hospitals are struggling and i'm

52:20 - and

52:21 - i think we have

52:22 - bumpy roads ahead

52:23 - and because of those hospitals rely very heavily on medicaid and as we know there are

52:27 - some challenges ahead with medicaid and funding

52:30 - and the more uninsured people we have the more challenging that will become

52:33 - so i think we need to have a lot of dialogue about how we can work together

52:37 - to address what i see as

52:39 - ongoing challenges but again from the department of health standpoint we are doing

52:43 - what we can around flexibilities meeting with them

52:46 - but i'm happy i see our time is up and i want to respect that this is the last

52:50 - hearing and you all want to get home.

52:53 - So i will not carry on but i'd

52:54 - be happy to be with you after the hearings to talk about

52:57 - how we can work together thank you doctor we can

52:59 - get something on the schedule i appreciate it

53:01 - thanks gentlemen

53:02 - representative mullins.

53:04 - That he was chairman and

53:05 - to all of you i appreciate you being here.

53:08 - It's good to see you.

53:09 - Secretary rogan

53:11 - it's great to

53:12 - be with you again last time we were together was

53:13 - out at the university of Pittsburgh meeting some

53:16 - of

53:16 - some of those

53:17 - amazing researchers trained to

53:20 - find

53:20 - cures therapies and treatments for.

53:23 - Some of our most

53:24 - devastating

53:25 - diseases

53:26 - so i really appreciated you making the trip i was with chancellor

53:29 - gable from

53:30 - a pit yesterday and had a chance to hear

53:33 - the update on.

53:35 - Their end as far as research dollars go.

53:38 - As you know we've taken important steps in recent years to address as

53:41 - neurodegenerative diseases

53:43 - including the creation of the first ever Alzheimer's dementia and related disorders

53:47 - division over in the department of aging.

53:49 - Requiring insurance providers

53:51 - to cover

53:52 - biomarker testing for the benefit of

53:55 - earlier diagnoses and precision medicine and.

53:58 - Most recently the allocation of five million dollars to support

54:01 - neurodegenerative

54:02 - research

54:03 - just wonder if you could give him an update on

54:06 - the status of that program as you can imagine

54:08 - these research institutions are excited about.

54:11 - That

54:12 - that funding and are anxious to put it to work.

54:16 - Yes

54:16 - thank you so much and thank you for really supporting that

54:19 - and

54:20 - that funding.

54:21 - As you know.

54:23 - Due to the delayed budget

54:25 - negotiations that happened and

54:27 - we really didn't

54:28 - know that we would have that funding to go out the door until late November so we

54:32 - have been working diligently to get the rfp together

54:35 - we expect that to be out

54:36 - soon

54:37 - and for people to be able to apply for those funds quickly so

54:41 - it's in the works

54:42 - our team has made it a priority

54:44 - and

54:44 - and again it has to go through the process of putting

54:47 - the rfp out for those who are eligible to apply

54:50 - and then for us to.

54:52 - Act

54:52 - Grant agreements with them so

54:54 - i'm

54:55 - not out yet at the rfp is on it's way and will be

54:57 - certainly happy to let you know as soon as it's posted

55:00 - there you go that's

55:01 - a

55:01 - very positive update and i appreciate it and

55:04 - the good news is that the governor has yet again proposed

55:07 - it as a

55:08 - now recurring line item.

55:10 - So will be will be

55:11 - fighting for that on our end.

55:13 - Our into the building.

55:15 - Switching gears

55:16 - is a significant portion of your budget is supported by federal funds.

55:22 - But you know we've got

55:24 - programs like the children's

55:26 - health insurance program

55:28 - and smoking cessation that

55:30 - rely on tobacco settlement funds but those

55:33 - dollars are

55:34 - on the decline.

55:36 - So

55:36 - just considering.

55:39 - Have

55:39 - has the department considered or can you comment on.

55:43 - An increase

55:44 - in revenues from

55:46 - tobacco sales and vape products to help stabilize these

55:49 - these critical programs.

55:52 - Sure yes

55:53 - the department of health budget is about sixty

55:56 - percent federal dollars and of course we've

55:59 - had some challenges but those federal dollars this past year

56:02 - and

56:03 - so we.

56:05 - Are always looking at our opportunities for supporting our programs

56:10 - and.

56:11 - As our are

56:11 - have a question around

56:13 - funding so there you write the settlement dollars have gone down because

56:17 - the good news is

56:18 - that fewer people are smoking and in

56:19 - Pennsylvania we actually have more former smokers

56:22 - than we do

56:23 - current smokers

56:24 - which is great which is exactly what we want to do so we continue to.

56:29 - Provide support around tobacco educate ocean

56:32 - vape education

56:34 - and

56:34 - really trying to discourage people from starting

56:36 - in the first place really focused on teens

56:39 - and

56:40 - and always happy to discuss opportunities for additional funding

56:43 - for those programs because as you can see they've been impactful

56:46 - and the fact that our smoking rates continue to decline speaks to that

56:50 - so

56:51 - but you're right the way we currently fund that is

56:54 - through

56:55 - it's kind of a catch twenty two right you're doing

56:56 - your good work and so then your funding goes down

56:59 - i

57:00 - go again happy to talk with you about opportunities for funding

57:03 - thanks so much

57:04 - and we definitely have opportunities to collaborate because also within our

57:07 - department we do have prevention programming

57:11 - and so

57:12 - we need to think about how we might integrate them of our work to continue not only

57:17 - educating the community around

57:19 - tobacco we recently

57:21 - as

57:21 - as a part of some of our training series we

57:24 - updated our

57:26 - training management system to

57:27 - to include

57:28 - i think three or four additional tobacco cessation trainings and so again

57:33 - always opportunities to think about how we will continue to collaborate.

57:38 - Update really appreciate it always works out

57:40 - with you to test fine together

57:42 - because

57:43 - your your missions are

57:45 - very much intertwined

57:47 - thanks for your service

57:48 - thank you

57:48 - thank the gentleman representative krupa

57:50 - thank you mr chairman and thank you all for being here this afternoon i want to.

57:55 - Base my questions around the proposal to legalize marijuana

58:00 - much of that conversation focuses on projected tax revenue

58:04 - and economic opportunity but what concerns me particularly as a member of this

58:08 - committee and is it the end of the community at large is.

58:12 - The other side of that ledger

58:14 - the public health impacts

58:16 - and the growing responsibilities that will fall on agencies like yours

58:20 - when it comes to addiction treatment emergency care and prevention efforts

58:25 - the Pennsylvania department of health will be responsible

58:28 - for tracking increases in emergency room visits

58:31 - accidental poisonings in children impaired driving injuries

58:34 - and maternal and fetal health risks at the same time

58:37 - the Pennsylvania department drug and alcohol programs

58:40 - will face the reality of increased cannabis dependency

58:43 - extended treatment expanded treatment needs

58:46 - and growing demand for prevention services particularly among young people

58:51 - we already know that today's marijuana products

58:53 - are far more potent than what existed decades ago

58:56 - we know that edible products are for frequently mistaken for candy by children

59:01 - we know that regular marijuana use is associated with mental health complications

59:06 - including anxiety depression and psychosis in vulnerable individuals

59:10 - and yet as lawmakers

59:13 - and when we debate legalization we rarely talk about

59:16 - the real question that that should concern everybody

59:19 - not just this committee

59:20 - what these policies would mean for the agencies tasked with protecting the health and

59:25 - safety of Pennsylvania so i want to focus

59:27 - my questions today on those practical implications and what legalization would mean

59:31 - for your departments and the challenges you would face

59:34 - and i and i have separated them into two buckets I'll start

59:37 - a secretariat welcome with you if that's okay.

59:39 - If the recreational marijuana is legalized the department of health would likely be

59:43 - responsible for monitoring the range of public health

59:46 - outcomes including

59:48 - increased emergency room visits

59:50 - related to marijuana intoxication

59:52 - the accidental ingestion by children from the edible products potential mental health

59:57 - 420 complications linked to high potency t h c

01:00 - 04.200 and all the all the conversations we had today about maternal health

01:00 - 08.073 we know that there will be issues with maternal health

01:00 - 11.920 and fetal health impacts related to prenatal exposure

01:00 - 14.157 and then there's going to be other marijuana related

01:00 - 17.200 hospitals what new system staffing or resources

01:00 - 21.420 with the department need to properly track and respond to those public health issues

01:00 - 25.230 does your current budget or your requested budget account for

01:00 - 27.490 for those increased and services.

01:00 - 30.540 Thank you for that question about the

01:00 - 31.620 adult use again

01:00 - 32.520 and

01:00 - 35.010 the department currently runs the medical program

01:00 - 36.090 and so

01:00 - 37.380 we have

01:00 - 37.980 the

01:00 - 39.480 resources from our

01:00 - 42.660 medical program and we've learned a lot from our medical program about

01:00 - 44.730 proper labeling and

01:00 - 45.750 packaging

01:00 - 50.160 and trying to really keep things away from children to make them uninterested so we

01:00 - 53.190 can learn from all those lessons and we can use the expertise we have

01:00 - 54.570 and in terms of

01:00 - 55.690 surveillance.

01:00 - 00.070 In our department as a lot of surveillance around infectious diseases

01:01 - 01.338 i see depart visits

01:01 - 05.478 so we have the experience and the know how in the department to continue to

01:01 - 07.468 expand that surveillance.

01:01 - 08.688 Particularly around

01:01 - 10.878 emergency department utilization

01:01 - 14.478 we work very closely with the poison control centers across the state

01:01 - 15.858 on surveillance

01:01 - 19.788 so again we have the expertise on surveillance already in the department

01:01 - 22.639 for that workforce perspective how would legalization

01:01 - 26.028 affect the department's ability to maintain drug free

01:01 - 28.938 work pays place standards and whether america

01:01 - 30.798 would marijuana legalization

01:01 - 33.438 complicate employee drug testing

01:01 - 34.248 or

01:01 - 38.968 policies or workplace impairment standards for state employees in that setting.

01:01 - 42.778 I think that's a question more for r.

01:01 - 43.788 Hr

01:01 - 45.408 teams and then for us

01:01 - 46.858 ok.

01:01 - 49.338 The pivoting then to secretary Davis Jones

01:01 - 54.418 and and these are questions that i think we could take days to to shift through

01:01 - 58.248 but research indicates that roughly one in three marijuana users may develop

01:01 - 00.658 some type of cannabis dependency

01:02 - 04.938 if recreational marijuana were legalized what is increasing cannabis use

01:02 - 08.676 disorder cases does deed app anticipate

01:02 - 11.326 and as Pennsylvania currently have sufficient

01:02 - 14.698 treatment capacity to absorb that potential increase.

01:02 - 17.608 Thank you for the question

01:02 - 19.468 I'll just start by saying

01:02 - 23.068 with legal illegal or illicit substances

01:02 - 24.108 the department of

01:02 - 28.408 drug and alcohol programs Michigan remains and that is to provide treatment

01:02 - 32.308 case management and recovery support services for individuals

01:02 - 33.138 throughout

01:02 - 36.738 the commonwealth should day develop a substance use

01:02 - 37.818 disorder

01:02 - 43.338 and so when you think about this from the perspective of us tracking you know the

01:02 - 45.588 prevalence of what may come to be

01:02 - 48.318 at this point in time we haven't been tracking

01:02 - 49.638 where that may

01:02 - 50.388 go

01:02 - 52.558 but what i will say.

01:02 - 55.188 We're always ensuring that

01:02 - 00.348 occur across the commonwealth with our single county authorities that we are doing

01:03 - 04.308 needs assessment and we're also developing prevention plans

01:03 - 05.688 with our single county at the

01:03 - 07.158 authorities and so

01:03 - 09.408 the great thing about that is that

01:03 - 13.368 each of those single county authorities also

01:03 - 15.838 our local drug and alcohol offices

01:03 - 18.644 and they have the opportunity to truly understand

01:03 - 22.018 what's happening in their geographical locations

01:03 - 26.238 and so by developing needs assessments developing those prevention plans

01:03 - 28.998 they will be able to earmark

01:03 - 32.628 funding not only for prevention treatment and other

01:03 - 34.788 recovery support services

01:03 - 36.468 in addition to that that

01:03 - 38.988 we do work hand in hand

01:03 - 40.398 with our

01:03 - 44.958 drug and alcohol offices and should there be the need for additional funding

01:03 - 47.248 we do have the opportunity

01:03 - 49.128 currently in place where a

01:03 - 50.598 single county

01:03 - 52.985 i keep saying any single county authorities are

01:03 - 55.428 our local drug and alcohol offices they do have the

01:03 - 57.768 the abyss shitty to ask

01:03 - 59.538 for additional resources

01:03 - 03.588 and should we find that our resources aren't able to

01:04 - 06.318 handle the demand

01:04 - 07.368 for treatment

01:04 - 09.738 of course we'll be advocating for additional funds

01:04 - 11.786 thank you i would love to ask more questions but the

01:04 - 15.208 chairman's going to throw a flag and made them to thank you.

01:04 - 17.158 The generally

01:04 - 19.018 representative Kincaid

01:04 - 20.698 thank you mr chairman

01:04 - 21.438 and

01:04 - 22.398 i want to

01:04 - 26.958 follow up on what chair Williams was asking about in terms of of create them and

01:04 - 30.439 it's a growing problem and it's something that I've had

01:04 - 34.648 a number of constituents come to me and talk about the.

01:04 - 37.357 Overdose issues that their children have

01:04 - 40.338 experienced i hadn't largely because create them is

01:04 - 41.568 easily accessible

01:04 - 44.429 the first time i saw create them it was sitting next

01:04 - 46.998 to pack of gum at a convenience store in a hotel

01:04 - 47.868 and

01:04 - 49.918 i find that incredibly problematic.

01:04 - 52.758 Especially given the seven o h

01:04 - 53.878 and.

01:04 - 55.468 Synthetic

01:04 - 56.758 aspects

01:04 - 58.528 and.

01:04 - 00.058 So.

01:05 - 02.568 Dr Davis Jones i

01:05 - 02.928 and

01:05 - 03.768 i kind of want to

01:05 - 06.558 follow up with what you were just talking about so

01:05 - 09.468 a number of these constituents have actually talked about

01:05 - 16.338 trying to get their children into treatment and then being rejected because a crate

01:05 - 19.008 them is not a serious enough substance for them to

01:05 - 20.278 receive.

01:05 - 21.958 Treatment.

01:05 - 23.538 Can you

01:05 - 25.218 kind of explain that or what is it

01:05 - 27.421 what is it that we can be doing to make sure that

01:05 - 29.208 that create them is a substance that we can be

01:05 - 30.168 treated for

01:05 - 33.948 part of that is education and that's what we've been talking about with our

01:05 - 36.318 interagency substance use response team

01:05 - 37.248 you know there's

01:05 - 40.308 there's this piece around public awareness training

01:05 - 43.042 we are also do have to you know ensure that our

01:05 - 45.768 workforce our healthcare providers whether it be

01:05 - 48.237 in hospital settings and within drug and alcohol

01:05 - 51.978 treatment facilities that they are appropriately trained

01:05 - 54.088 and equipped to address

01:05 - 56.448 an intoxicating hemp products right

01:05 - 00.558 and so again we are exploring our options

01:06 - 04.548 but we he recognize that this is an important issue and we will be

01:06 - 08.418 developing a commonwealth wide response to addressing this

01:06 - 11.808 thank you i think intoxicating hemp is really

01:06 - 15.258 important to address as well but it's not that's not what kratom is

01:06 - 16.248 and

01:06 - 17.328 and and actually that

01:06 - 19.548 segues well into my next question which is

01:06 - 23.028 we are seeing a lie lot of substances.

01:06 - 28.458 Become available intoxicating substances from natural products

01:06 - 34.008 that are in this legal gray area where there is no regulation there is no control

01:06 - 39.358 and we can regulate intoxicating hemp we can regulate create them.

01:06 - 44.548 But is there something more or that we could be doing to ensure that we are catching

01:06 - 50.368 more of these legal substances that are in this gray area to prevent

01:06 - 55.078 them from becoming issues like create them like intoxicating him.

01:06 - 59.268 You know i

01:06 - 59.928 i

01:07 - 01.188 i hear you i

01:07 - 05.268 have similar concerns right it's it's a little bit like playing whack-a-mole you get

01:07 - 07.788 one down you'll get another one coming up

01:07 - 09.748 i think really

01:07 - 12.768 we need to make sure that everyone understands what they're purchasing

01:07 - 14.838 right and there's it

01:07 - 16.938 is a market out there that's

01:07 - 18.118 extensive

01:07 - 20.405 so i think for us the department of health really

01:07 - 22.908 focuses on education so how do we make sure

01:07 - 24.168 that people know

01:07 - 25.128 what are the

01:07 - 26.838 potential effects of this

01:07 - 28.908 how do we make sure that people are

01:07 - 30.468 smart about what they're

01:07 - 33.108 exposing themselves to and making sure that parents

01:07 - 37.158 understand where and how their children can purchase these products and we want to

01:07 - 38.478 keep them out of the hands of children

01:07 - 40.886 so again i think we have a lot of work ahead of

01:07 - 43.098 us i don't have any magic solutions but i think

01:07 - 46.588 we need to make sure that it is part of education

01:07 - 51.408 and widely discussed and that it's not kind of this behind the scenes

01:07 - 52.188 thing that we're

01:07 - 53.568 we all need to face

01:07 - 56.118 like you you can walk into a store and there's as

01:07 - 57.168 a variety of

01:07 - 59.388 unregulated products and we don't know

01:07 - 03.738 you don't even know if what they say is on the label is actually what's in the

01:08 - 05.928 container that's how unregulated there so

01:08 - 08.193 share your concerns and love to have small

01:08 - 10.488 conversations about how we can work together

01:08 - 12.028 because i think.

01:08 - 15.283 There's not one solution to this it really is going to take all

01:08 - 18.018 kind of working together to figure out how do we reduce this

01:08 - 21.658 but again it's definitely a concern for all of us here.

01:08 - 23.238 Yeah i i mean i think

01:08 - 23.928 to your point

01:08 - 26.328 it is like whack-a-mole and and i think

01:08 - 29.196 there has to be a way that we can get ahead of this

01:08 - 32.878 so that we are not constantly responding to the next.

01:08 - 36.905 You know gray area legal substance that's available kids

01:08 - 41.037 until we finally legislate to a place that that it actually

01:08 - 46.498 is regulated has to be behind the counter you need an ID to buy it that kind of stuff

01:08 - 49.308 and so i would love to to work with both of you to

01:08 - 52.158 figure out how it is that we do that because

01:08 - 56.538 i think that there are there is a place for these substances if you use them

01:08 - 59.320 responsibly if you as a consumer know what it is that

01:08 - 01.578 you're ingesting so thank you thank you mr chairman

01:09 - 02.968 thank you.

01:09 - 05.968 Thanks gentle lady representative awesome.

01:09 - 07.998 Thank you mr chairman

01:09 - 12.708 this quest first question is for you just wondering if chairman strozzi gets a red

01:09 - 15.688 flag since you have a yellow flag.

01:09 - 17.368 Yeah.

01:09 - 19.428 So

01:09 - 22.534 secretaries is great to see you here this

01:09 - 26.458 afternoon and my question is for doctor bogdan.

01:09 - 27.588 Bogan

01:09 - 29.115 and

01:09 - 32.928 and before i get into it i want to thank you for all your help with the

01:09 - 37.998 pike county micro hospital setting us up on the right path you and your team

01:09 - 41.638 and our stakeholders and local officials

01:09 - 44.298 to get on the right path right in the beginning

01:09 - 46.738 things are progressing there.

01:09 - 50.028 If i have a chance at the end I'll circle back to that

01:09 - 51.718 but madam secretary.

01:09 - 57.918 We continue to hear from nursing facilities across the state about challenges with

01:09 - 00.508 the department's staffing mandates

01:10 - 05.336 and the associated impacts amid ongoing workforce shortages

01:10 - 07.608 including worsening hospet will

01:10 - 09.628 discharge delays.

01:10 - 14.038 We hear from hospitals and nursing facilities alike.

01:10 - 16.008 On the strain this puts

01:10 - 16.668 on

01:10 - 19.288 healthcare on the health care continuum.

01:10 - 26.358 While well intended do you agree that these regulations are a barrier to accessing

01:10 - 28.288 post acute care.

01:10 - 31.428 I appreciate that question

01:10 - 34.588 we've been doing a lot of work on our long term care.

01:10 - 38.418 Facilities and and really working on quality of care

01:10 - 39.748 so

01:10 - 43.308 the long term care regulations passed in two thousand twenty two

01:10 - 47.248 i started in two thousand and twenty three as they were being implemented

01:10 - 50.058 and in the first year we heard a lot of concerns about

01:10 - 52.608 staffing and issues with staffing

01:10 - 53.868 and i will say that

01:10 - 58.308 we've been tracking as we go out for our surveys to see how we're doing

01:10 - 59.628 around staffing

01:11 - 04.138 and i'm happy to report actually that we have most of the facilities.

01:11 - 07.308 Are not having staffing challenges in terms of

01:11 - 09.478 meeting the regulations.

01:11 - 11.826 The facilities that seemed to be having

01:11 - 14.796 staffing challenges are also the ones in general

01:11 - 16.446 that are not meeting other

01:11 - 19.066 of our regulations and so.

01:11 - 21.892 It does mean that some facilities have reduced

01:11 - 24.286 the number of people in the facilities.

01:11 - 26.646 So that they can meet the staffing but again

01:11 - 28.146 you and i want to make sure

01:11 - 29.856 that when we drop off our lot

01:11 - 30.726 one at a

01:11 - 32.106 skilled nursing facility

01:11 - 33.816 that they get quality of care

01:11 - 37.566 and this really is an issue of quality ensuring quality of care

01:11 - 41.556 and the staffing ratios have been demonstrated or the staffing requirements

01:11 - 43.146 have been demonstrated to

01:11 - 45.816 really make sure that people are getting the care they need

01:11 - 49.806 we have not heard about delays in the last year around

01:11 - 54.066 hospital discharges the ones we have looked into around those delays

01:11 - 56.736 actually turn out to be more insurance related

01:11 - 58.116 than staffing related

01:11 - 00.606 and so if you're hearing specific hospitals

01:12 - 01.986 having discharges

01:12 - 04.051 that are related specifically to staffing and long

01:12 - 06.516 term care i'd love to have a conversation about that

01:12 - 09.946 but we have been tracking really closely through our.

01:12 - 13.446 Sir survey process what is in the impact and again i'm thrilled

01:12 - 16.626 to say that the facilities are meeting the regulations

01:12 - 17.706 for the most part

01:12 - 19.746 and again we are working

01:12 - 20.940 my focus and

01:12 - 24.366 my team's focus is really on ensuring quality of care

01:12 - 27.706 in our long term care facilities and staffing appropriately

01:12 - 30.336 is part of that quality issue but again if you're here

01:12 - 34.056 specific ones i'd be happy to discuss that with you because we want to make sure

01:12 - 37.056 that we are meeting the needs of Pennsylvania and

01:12 - 37.896 i could

01:12 - 39.306 sorry if i could just add one thing

01:12 - 41.436 i think the other factor in addition to what

01:12 - 43.919 secretary bogan mentioned about quality for patients is

01:12 - 46.506 really quality for the workers i know you had mentioned

01:12 - 51.156 concerns about workforce we all know that there's concerns about the the workforce

01:12 - 53.946 structure within our commonwealth for healthcare but

01:12 - 58.866 adequate staffing is really helpful to keep the workforce and make sure that they

01:12 - 02.676 know what they're doing they're trained they have support when they need it

01:13 - 04.746 and so actually part of the

01:13 - 07.506 reasoning for the staffing requirements in the long term

01:13 - 10.710 care facilities was actually for staff quality and really

01:13 - 14.386 to make sure that their work balance was appropriate

01:13 - 18.256 and so it just wanted to also mention that part because i think it's important.

01:13 - 19.926 And you did you'd

01:13 - 25.126 you know when these regulations were enacted you you did state.

01:13 - 27.846 That it would increase the quality of care

01:13 - 28.776 so

01:13 - 33.576 do you have any data to support the claim and can you provide that to

01:13 - 35.196 to the committee i know

01:13 - 37.326 do you have concrete

01:13 - 39.286 data of that.

01:13 - 42.196 We we have data on the.

01:13 - 47.849 The numbers of facilities that are not meeting regulations when we visit and and.

01:13 - 49.596 Working with them on that

01:13 - 50.916 and yes we have

01:13 - 52.356 us that kind of data

01:13 - 53.526 around and.

01:13 - 58.746 Whether people what the impact on the workforce i can tell you that we did our

01:13 - 02.886 long-term care transformation office funded quality investment pilot projects

01:14 - 07.686 and one of the goals of those projects went about to about one hundred facilities

01:14 - 09.756 across the commonwealth small amounts of money

01:14 - 12.936 a big focus of that was on workforce training

01:14 - 14.106 and support

01:14 - 15.426 and what we saw

01:14 - 17.826 we did an analysis through an independent

01:14 - 18.756 evaluator

01:14 - 20.316 evaluator and

01:14 - 22.486 determined that actually.

01:14 - 26.466 The folks that got this small amount of money focused on workforce

01:14 - 27.694 actually saw

01:14 - 29.466 less use of

01:14 - 31.116 contracted staff

01:14 - 33.996 more regular way less turnover in their staff

01:14 - 35.676 and consistency and we know

01:14 - 38.616 consistency and staff actually it's also really important

01:14 - 41.706 so we have that data we put out a short report about that

01:14 - 44.406 i'm happy to share that about the importance of

01:14 - 49.026 really making sure that your workforce is cared for and have small differences can

01:14 - 49.836 really

01:14 - 52.576 amplify the impact and quality.

01:14 - 54.156 Pinky madam secretary

01:14 - 55.906 thank you mr chairman.

01:14 - 58.468 Gentlemen representative Salisbury

01:14 - 00.136 thank you chairman.

01:15 - 03.636 Today i'd like to talk a little bit about pseudoscience

01:15 - 11.526 i have i have grave concerns about the growing influence of pseudoscientific theories

01:15 - 15.316 at the federal level of government and

01:15 - 20.436 as it relates in particular to autism but in many many respects whether it be

01:15 - 24.726 vaccine information or a variety of different types of

01:15 - 27.396 homeopathic remedies that have been

01:15 - 29.496 accepted so we see people for

01:15 - 31.356 instance being replaced on

01:15 - 33.966 federal commissions who have what would have it

01:15 - 36.706 previous years been considered fringe.

01:15 - 38.806 Scientific ideologies

01:15 - 44.106 so based on what's going on federally i do feel that we have an obligation of the

01:15 - 47.836 state level to try to continue to provide

01:15 - 50.046 real science as opposed to pseudoscience

01:15 - 51.606 and i'm curious what

01:15 - 54.616 your department is doing in furtherance

01:15 - 56.236 of those goals.

01:15 - 59.616 Thank you and representative for that question

01:16 - 01.336 i'm going to.

01:16 - 04.546 Talk about vaccines if it's okay because i think that

01:16 - 07.956 has been a huge focus of the department for the last year

01:16 - 11.746 in response to some disinformation and misinformation

01:16 - 13.056 that has been coming out

01:16 - 14.416 so.

01:16 - 17.376 The advisory committee on immunization practices has

01:16 - 19.176 has been a long standing committee

01:16 - 21.286 and that is actually.

01:16 - 24.546 Through law required to exist and the

01:16 - 29.116 people who are supposed to serve on that committee i have to meet very specific

01:16 - 31.194 training requirements and regulations and

01:16 - 34.306 they need to be true scientists with expertise

01:16 - 35.526 and as you know

01:16 - 39.193 last year at the seven team member or a cip committee

01:16 - 41.916 was disbanded and a new committees were appointed

01:16 - 45.666 and frankly many of the people on that committee don't actually meet

01:16 - 46.966 the criteria.

01:16 - 49.296 For that is laid out in

01:16 - 52.146 legislation around who should be on those committees

01:16 - 54.336 and what their expertise should be

01:16 - 56.659 and as you know the governor participated with

01:16 - 00.406 fourteen other states on a lawsuit specifically around.

01:17 - 02.722 That committee and the requirements

01:17 - 03.636 for being on the

01:17 - 04.786 committee.

01:17 - 07.956 So we have been working extremely hard to provide

01:17 - 09.106 education

01:17 - 14.256 and to put out guidance around vaccines that is evidence based

01:17 - 15.736 that is.

01:17 - 20.706 I want to be clear no science no new science has been introduced to change the

01:17 - 22.806 recommendations for vaccines right

01:17 - 26.166 it is there's no new science the science is the same

01:17 - 30.546 and the recommendations unfortunately have changed despite no new science

01:17 - 34.546 lots of salutations federally to discredited studies though.

01:17 - 38.279 So with you we are working extremely hard the governor

01:17 - 42.006 did his executive order in October to safeguard vaccines

01:17 - 43.266 for Pennsylvania and

01:17 - 47.946 we were asked to do a number of things that the department one was to create a single

01:17 - 50.556 website where all of our vaccine information lives

01:17 - 53.026 pa dot gov slash vaccines

01:17 - 56.046 that data is available we been promoting that

01:17 - 57.556 we also

01:17 - 58.326 have

01:17 - 01.357 been meeting with a work group of experts from across

01:18 - 03.996 the state on how do we make sure we get out science

01:18 - 06.576 our communications team has been working on

01:18 - 10.056 using best practices around disseminating information

01:18 - 10.866 we've been

01:18 - 13.686 our videos have been very popular we asked

01:18 - 15.666 pediatricians across the sea state

01:18 - 19.696 to make videos about the truth about vaccines

01:18 - 21.756 and those videos have been popular

01:18 - 24.616 i'm also just going to say as a pediatrician

01:18 - 25.266 I've

01:18 - 27.486 I've had thirty years of pediatric

01:18 - 29.586 experience if you count my residency in

01:18 - 30.246 all my

01:18 - 30.636 work

01:18 - 35.616 and I've got to personally see the introduction of new vaccines and the end pact

01:18 - 36.966 they've had on the health of children

01:18 - 40.716 so i'm just going to give you a couple of quick examples when i started practice

01:18 - 41.436 and

01:18 - 42.845 we used to

01:18 - 46.926 every time a child came in with a fever without a source who was less than age three

01:18 - 49.296 as pediatricians we would do a spinal tap

01:18 - 51.036 a urine culture and a blood culture

01:18 - 54.336 because strep pneumo and haemophilus influenza type b

01:18 - 58.026 would be particularly bad the actors in that age group and so we would do this

01:18 - 00.456 enormous work up to make sure that they didn't have it

01:19 - 06.036 while after him office influenza type b and strep pneumo vaccines were introduced the

01:19 - 08.560 entire practice of medicine changed and we stop having

01:19 - 10.956 to do that workup if children have those vaccines

01:19 - 12.306 so saving

01:19 - 13.536 dollars and pain

01:19 - 15.406 to children and families.

01:19 - 19.266 The rotavirus vaccine in the first year was introduced in two thousand and six

01:19 - 22.716 cut in half the number of hospitalizations that children had

01:19 - 24.186 for diarrheal illness

01:19 - 25.446 less than age five

01:19 - 27.396 and that has continued to decline

01:19 - 31.066 as a matter of fact we rarely now admitted child for rotavirus

01:19 - 32.046 and

01:19 - 35.286 i could go on and on about all of the vaccines that have been effective

01:19 - 37.056 and it's very sad for me

01:19 - 39.996 because parents are trying to do the right thing for their children

01:19 - 44.406 right they have what's best interests they're just being given information that isn't

01:19 - 46.566 accurate and so that is very hard

01:19 - 51.396 so i think we have a lot of work ahead i appreciate your support of of.

01:19 - 54.970 Science and the evidence and i'm happy to work with

01:19 - 58.096 all of you on this dominating accurate information

01:19 - 01.986 and to tell the stories that i think people need to hear and understand so they can

01:20 - 04.846 make the best informed decisions for their families.

01:20 - 11.316 I might be from the last group of people to have chicken pox scars so i definitely

01:20 - 13.506 appreciate the innovation of new vaccines

01:20 - 18.106 and if i may ask one last question chairman if you I'll indulge me one quick question

01:20 - 19.756 one quick question.

01:20 - 24.826 I would be remiss if i did not inquire when we.

01:20 - 30.104 Will see some movement on getting gaucher disease tested for it birth.

01:20 - 31.456 So.

01:20 - 33.516 As you know i testified at a hearing

01:20 - 34.836 back in the fall

01:20 - 36.186 so go chaise

01:20 - 40.326 was re applied for i'm just going to say that you all passed a great law

01:20 - 44.916 back in his training nineteen or twenty making sure that Pennsylvania lines with the

01:20 - 48.696 rec recommended uniform screening practices which we do

01:20 - 53.376 and we have added a couple of conditions based on our committees as well which is

01:20 - 54.906 part of the structure you laid out

01:20 - 00.346 so our committee that reviews applications outside of the rest

01:21 - 00.786 and

01:21 - 01.656 is

01:21 - 02.226 god

01:21 - 06.216 put together a subcommittee and that subcommittee will review the application again

01:21 - 09.036 and see if there's any new information that would change the decision

01:21 - 11.586 and then if they recommend that it be

01:21 - 15.366 added then it would go to the full committee at the next meeting

01:21 - 16.596 so that the

01:21 - 17.946 committee has been formed

01:21 - 20.736 they're trying to find a date i think they may have have a date for

01:21 - 21.673 but

01:21 - 22.682 we don't

01:21 - 25.352 i can't tell you exactly but it's it's in the works

01:21 - 27.062 i'm happy to get back to as soon as i know

01:21 - 31.112 my see that my mother has taught the chairman the certain look to give me

01:21 - 32.312 when

01:21 - 36.282 it's time to wrap it up so that you can tell this is the end of the hearings.

01:21 - 37.592 Digital

01:21 - 39.492 representative Nelson.

01:21 - 41.132 Thank you mr chair

01:21 - 44.282 welcome secretary's a real quick i just wanted to

01:21 - 48.662 thank you again secretary David Jones for your visit to westmoreland county

01:21 - 50.462 your support of aftercare

01:21 - 53.556 your our again a year over year decline on our

01:21 - 56.522 overdose deaths you know so it's it's great to see.

01:21 - 57.482 That's

01:21 - 58.142 working

01:21 - 59.612 my questions

01:21 - 00.272 are

01:22 - 03.342 going to continue in the area of.

01:22 - 04.652 Maternal

01:22 - 06.872 mortality you know we have

01:22 - 07.652 your

01:22 - 08.432 two hundred

01:22 - 10.142 your two thousand and twenty five

01:22 - 11.442 maternal

01:22 - 14.192 mortality report before the committee

01:22 - 15.272 and in twenty

01:22 - 16.742 four twenty five

01:22 - 19.392 the budget had five million dollars

01:22 - 21.782 to address maternal mortality

01:22 - 22.562 in mobile

01:22 - 23.162 in

01:22 - 25.032 morbidity d.

01:22 - 26.372 We didn't spend

01:22 - 27.932 all of that money

01:22 - 32.082 you know it looked like there were about three million dollars three point four.

01:22 - 36.452 That was held over but there's another two and a half million being

01:22 - 37.782 requested

01:22 - 39.032 what's your intended

01:22 - 41.952 purpose of these unspent funds

01:22 - 42.542 sure

01:22 - 45.242 i can get back to the specifics but we have

01:22 - 48.152 Joe just funded a bunch of rf ps that had gone out

01:22 - 50.736 on those maternal health work so.

01:22 - 56.552 That data could be updated with that funds and we have allocated all of the funds

01:22 - 58.322 that we were issued already

01:22 - 59.462 the request

01:22 - 01.592 for the next two and a half million

01:23 - 03.332 is really to focus on

01:23 - 06.912 child death review process as well well as.

01:23 - 08.942 Let me explain to you what that is so

01:23 - 10.812 that's okay.

01:23 - 11.732 So we do

01:23 - 15.992 that the money i believe that you're talking about has all been allocated through rfp

01:23 - 17.762 processes and the reason it wasn't

01:23 - 21.422 clear in that that some of them were still working their way through the process

01:23 - 22.472 and you've got the budget

01:23 - 23.342 so

01:23 - 26.982 in this twenty twenty five report.

01:23 - 28.314 You and

01:23 - 30.572 reading the report it's showing that

01:23 - 32.732 Pennsylvania residents ninety seven deaths

01:23 - 33.872 per one hundred thousand

01:23 - 36.162 but when we look at the CDC

01:23 - 38.952 again for decades or the march of dimes.

01:23 - 41.282 They list us at eighteen

01:23 - 41.852 point

01:23 - 42.602 six

01:23 - 44.102 percent for one hundred thousand

01:23 - 46.832 which is which is a stark contre last and

01:23 - 48.512 first i was confused

01:23 - 50.650 and then i got frustrated as i was getting

01:23 - 53.442 into the report and realizing that Pennsylvania

01:23 - 55.772 in this mortality morbidity report

01:23 - 58.772 is not following CDC guidelines

01:23 - 59.702 i mean even

01:24 - 03.722 in your own report on page seven your first finding

01:24 - 08.582 you know acknowledges fifty pursue approximately fifty percent

01:24 - 09.932 of the

01:24 - 12.762 fatalities were not pregnancy

01:24 - 13.872 related

01:24 - 14.432 so

01:24 - 18.522 like there's this difference here that CDC for decades.

01:24 - 19.592 Has been

01:24 - 25.022 using maternal mortality as during pregnancy or within forty two days and

01:24 - 28.472 the death must be related or aggravated by pregnancy

01:24 - 30.042 but Pennsylvania.

01:24 - 35.162 We've created this term Pennsylvania associated

01:24 - 37.562 and we're using pregnancy and up to a year

01:24 - 39.032 which then brings in

01:24 - 43.712 overdose suicide murders cardiomyopathy with the and

01:24 - 48.342 continued mental health conditions why why doesn't your.

01:24 - 52.482 Report not mention this def diff difference.

01:24 - 58.022 So the report does explain that there are different depending on whose

01:24 - 01.652 criteria you use for maternal mortality whether you define it as

01:25 - 03.582 death during pregnancy.

01:25 - 04.652 Delivery

01:25 - 06.542 or forty two days postpartum

01:25 - 08.568 vs the entire year and there's been a lot of

01:25 - 10.802 discussions nationally about what should be done

01:25 - 13.412 so are we have consistently used

01:25 - 15.852 the up to one year postpartum

01:25 - 19.172 in our analysis and report because

01:25 - 20.132 and again

01:25 - 25.679 the CDC also has pregnancy related versus pregnancy so lch did so it is this an

01:25 - 27.512 important distinction it is under.

01:25 - 30.422 Sanction and it makes a

01:25 - 33.242 big difference because i'm concerned about

01:25 - 35.402 the priorities you know last

01:25 - 36.782 this past Sunday and

01:25 - 39.452 in church we had a visiting pastor and

01:25 - 43.322 you know that pastor spoke that the the devil rides the fence

01:25 - 44.342 you know so so.

01:25 - 47.622 In your report you.

01:25 - 51.302 On page twenty three you have twenty one percent

01:25 - 51.962 of

01:25 - 53.642 the deaths as rural

01:25 - 55.172 seventy nine percent

01:25 - 56.342 as urban

01:25 - 57.332 and we're

01:25 - 59.312 in a bipartisan way

01:25 - 03.182 working to put millions of dollars to reduce preventable death

01:26 - 05.402 but there is a car contrast between

01:26 - 08.022 two thousand and twenty one data.

01:26 - 11.222 Which you're using in two thousand

01:26 - 13.232 twenty six where we now have

01:26 - 16.112 twenty three counties that are maternity care desert

01:26 - 21.162 how can we be assured that these zones are going to be adequately funded.

01:26 - 22.572 Equally.

01:26 - 26.942 So we do use our data

01:26 - 30.782 to make sure that we are thinking about where the funds need to go and that's why

01:26 - 32.612 data is so important in a funding

01:26 - 33.512 decision

01:26 - 34.352 and

01:26 - 35.552 the

01:26 - 36.702 the.

01:26 - 38.112 Coalitions.

01:26 - 40.502 Work across the regions

01:26 - 41.312 and

01:26 - 45.722 and we're also looking at the rural how transformation plan funds that have

01:26 - 49.562 really our focus one of the main categories of that is certain maternal health

01:26 - 51.722 focused in rural areas

01:26 - 56.162 so again i'm happy to meet with you afterwards and review the report in more detail

01:26 - 58.022 if that'd be helpful i don't have it in front of me

01:26 - 00.212 to go through but i think to

01:27 - 01.772 be understanding that

01:27 - 06.122 wreck the maternal mortality review commit he makes recommendations on how we can

01:27 - 08.222 address maternal mortality issues

01:27 - 12.422 and we then the funding we've been used to really try to address those

01:27 - 16.472 and we are working across the entire state including in rural areas

01:27 - 19.112 on education and blood pressure monitoring

01:27 - 20.442 and.

01:27 - 22.022 All kinds of services for

01:27 - 24.032 er pregnant people and postpartum so

01:27 - 24.313 and

01:27 - 25.082 in mr chair

01:27 - 25.682 i know

01:27 - 26.702 prior

01:27 - 28.352 test fires or questioners

01:27 - 31.232 on this subject of maternal health were given a little leave i just

01:27 - 33.422 i really there are two

01:27 - 35.342 extremely different worlds

01:27 - 38.262 when we look at actual internal death.

01:27 - 40.332 That is mental health.

01:27 - 43.152 Cardio cardiac or coronary.

01:27 - 45.272 Hemorrhages being in injuries

01:27 - 47.852 when we look and you mentioned those national groups

01:27 - 49.682 when we look at their priorities

01:27 - 50.342 that is

01:27 - 51.522 obesity.

01:27 - 55.202 Twenty nine percent discrimination thirty two percent

01:27 - 57.482 mental health conditions twenty two percent

01:27 - 58.682 and overdose

01:27 - 59.642 twenty four percent

01:27 - 00.362 so

01:28 - 02.412 we need to understand

01:28 - 05.492 how in a bipartisan way manner we are of

01:28 - 08.292 investing equally and appropriately

01:28 - 08.912 for

01:28 - 10.722 maternal health.

01:28 - 11.792 Can you understand my

01:28 - 13.050 concern.

01:28 - 14.290 I i.

01:28 - 14.822 I

01:28 - 17.552 i think i'm losing some of the detail but what i can say as

01:28 - 18.812 a death of a mother

01:28 - 21.342 leaves if a child without a mother.

01:28 - 24.332 Whatever the cause and we need to make sure were really trying to

01:28 - 25.832 do all we can

01:28 - 28.442 to make sure that mothers have the care they need

01:28 - 30.212 across the entire spectrum

01:28 - 31.322 right and

01:28 - 33.512 any maternal death is a loss

01:28 - 35.702 for that family and for that community so

01:28 - 37.202 i'm happy to work with you

01:28 - 39.122 this is an area where i spent my

01:28 - 41.672 career as a pediatrician working at the

01:28 - 44.192 intersection of maternal and child health

01:28 - 48.332 and i did a lot of work in pregnancy and this is a passion area so if you would like

01:28 - 50.162 to meet after this hearing and talk about

01:28 - 52.435 making sure we're distributing funds properly

01:28 - 54.602 i would be thrilled to have that conversation

01:28 - 56.492 it is important that we address

01:28 - 57.842 all of the issues

01:28 - 00.942 and that we do it in a fair and even way.

01:29 - 02.522 Thank you i appreciate the latitude

01:29 - 04.032 mister chair.

01:29 - 05.702 I'm docking you next year

01:29 - 07.992 that they're.

01:29 - 08.675 Putting in a

01:29 - 11.322 representative at me.

01:29 - 13.679 Thank you mr chairman and thank you to both

01:29 - 15.542 our secretaries and your staff for being here

01:29 - 18.007 i wanted to talk a little bit about last year we

01:29 - 20.192 pass out of the house house bill twelve twelve

01:29 - 23.642 the pa dads matter act which is currently sitting in the senate.

01:29 - 27.692 That is legislation that is designed to have the department of health do a

01:29 - 29.962 like an education campaign about the important

01:29 - 31.862 role that fathers play in maternal health

01:29 - 33.732 it would also

01:29 - 38.432 provide some guidance to healthcare practitioners and

01:29 - 41.126 to not necessarily create new program for fathers but

01:29 - 43.592 to figure out how they can be more inclusive of fathers

01:29 - 46.112 in the programs that they already they already have

01:29 - 48.474 for mothers and i use always give the example

01:29 - 50.642 of i have two kids i have two young sons

01:29 - 52.742 and enduring both prayer Tennessee's

01:29 - 54.773 there are many times we will go to the doctors

01:29 - 57.152 where i would feel like i'm on an island by myself

01:29 - 59.072 i'm sitting in the waiting room waiting to

01:29 - 00.212 figure out what's going on

01:30 - 02.462 i know my wife on both occasions

01:30 - 06.302 have multiple sessions where she would have sort of like mental health screenings

01:30 - 07.532 where they will check on her mental health

01:30 - 10.802 and i was always think like i wish somebody would check on my mental health like

01:30 - 13.424 as i want to know why people know what's going on with me

01:30 - 16.272 how i'm feeling emotionally and physically and mentally

01:30 - 18.062 but had never really happened and so

01:30 - 19.202 was trying to figure out

01:30 - 22.802 how we can incorporate fathers into those type of programs and activities

01:30 - 25.112 so want to see if you could give some insight on

01:30 - 27.902 the important role that fathers play when it comes to maternal health

01:30 - 28.952 and

01:30 - 30.542 i so appreciate your

01:30 - 31.742 asking that question

01:30 - 32.372 and i'm going to

01:30 - 34.232 my pediatrician had on for a minute

01:30 - 35.702 because like you

01:30 - 36.422 i'm

01:30 - 38.882 really making sure that there's a

01:30 - 39.302 at

01:30 - 39.962 you know

01:30 - 40.922 family is

01:30 - 42.242 broadly termed

01:30 - 45.512 and that people have support and get support and we know

01:30 - 47.282 actually from the medical literature

01:30 - 48.822 that fathers.

01:30 - 52.052 Also suffer from postpartum depression and anxiety

01:30 - 54.482 and just like new moms do so

01:30 - 58.902 it is an important issue and for awhile in our clinic we did screen fathers.

01:30 - 02.432 For depression as well and offered that time again that's my pediatric

01:31 - 03.272 hat on

01:31 - 05.072 and we did part of

01:31 - 07.982 Pittsburgh study that i helped work on we also screened

01:31 - 10.262 our fathers and found pretty high rates of

01:31 - 12.182 again it's stressful to have a newborn

01:31 - 13.952 and to go through a pregnancy

01:31 - 16.052 for all members of the family right

01:31 - 17.342 for the other children

01:31 - 20.257 for that support partners and

01:31 - 24.662 and i think there is a growing understanding that we need to really support

01:31 - 29.102 not just mothers but the whole family unit right because the family unit is what

01:31 - 30.152 provides

01:31 - 32.912 and family can defined broadly it can be grandpa

01:31 - 34.096 it could be

01:31 - 34.756 and

01:31 - 37.816 you know neighbors and friends but communities really support

01:31 - 41.456 and so yes i appreciate fathers

01:31 - 42.376 and matter of fact

01:31 - 43.096 i think

01:31 - 44.236 when i first started

01:31 - 45.256 clinical practice

01:31 - 47.866 i didn't have a lot of fathers coming to care

01:31 - 51.676 and i really appreciated that over the thirty years i was there

01:31 - 56.176 that fathers often by the way came alone to pediatric care with their children so it

01:31 - 58.426 it it's really important that we recognize

01:31 - 59.626 of the role of

01:31 - 01.726 fathers in this process and

01:32 - 03.496 provide them the support that they need

01:32 - 05.239 happy to think with you about how to do that i

01:32 - 07.636 think some of the opportunities in medical education

01:32 - 10.066 but again not necessarily in the role of

01:32 - 12.146 the departments specifically

01:32 - 16.216 but i think they are real opportunities to make sure people understand what's out

01:32 - 19.586 there in the literature and the support that people need

01:32 - 23.116 to be able to be the best parents that they can write that's the goal

01:32 - 25.996 is that parents are supported to be able to

01:32 - 30.136 nourish themselves and their children so we have optimal growth and development

01:32 - 33.616 and that we are happy to work with you on ways to make sure

01:32 - 37.306 that all parts of the family unit get the support they need so that they can

01:32 - 39.196 raise and support healthy

01:32 - 41.756 children to become healthy adults.

01:32 - 45.556 I was one of the system in a bipartisan way we emphasize

01:32 - 47.956 what rip Nelson was talking about and though there's

01:32 - 49.792 folks on both sides of it all that want to make

01:32 - 51.586 sure that this administration and the governor

01:32 - 53.066 is really.

01:32 - 53.656 You know

01:32 - 56.996 lifting up the importance of maternal health

01:32 - 59.342 and not just talking about it but actually putting the

01:32 - 01.576 resources behind it to address the issues in our commonwealth

01:33 - 03.826 this really quickly much the second question is for

01:33 - 04.546 an

01:33 - 06.256 actor David Jones secretary

01:33 - 06.916 thank you good

01:33 - 07.276 good

01:33 - 09.046 good to see you again always yes

01:33 - 11.636 and i want to talk a little bit about the

01:33 - 15.266 stigma around folks who were receiving services

01:33 - 20.546 and what is deeded doing in terms of initiatives or programs

01:33 - 21.986 to try to.

01:33 - 25.936 Push back ak on that stigma that we know still exists and continues to grow

01:33 - 29.776 yeah well thank you for that question you're you're absolutely right

01:33 - 32.356 stigma is alive and well

01:33 - 35.386 and so one of our major initiatives

01:33 - 38.896 is our antisemitic my campaign our life unites us

01:33 - 40.816 campaign so for all of

01:33 - 43.016 the legislators that are still here if you have i

01:33 - 49.329 had an opportunity to go visit our life in Isis campaign please do to

01:33 - 52.426 please do so it's life united dot com

01:33 - 56.786 but what i can tell you is we recognize that.

01:33 - 58.786 Stigma keeps people

01:33 - 01.096 from getting the help that they need

01:34 - 03.436 and we also know that that.

01:34 - 05.506 As a part of

01:34 - 06.586 our work that we're

01:34 - 08.566 we're doing to reduce stigma

01:34 - 12.056 we we recognize that if we don't.

01:34 - 13.856 Get people

01:34 - 16.226 that have lived experience

01:34 - 17.996 talking about.

01:34 - 20.975 That recovery is possible and that there is

01:34 - 25.076 hope the likelihood of others taking care is.

01:34 - 27.226 Significantly reduced and so

01:34 - 29.116 as a part of our work with

01:34 - 31.466 penn state university

01:34 - 35.416 along with a few other collaborators we're seeing that

01:34 - 36.766 individuals

01:34 - 42.016 and recovery are sharing their stories and we recognize that through

01:34 - 44.456 of the work of this campaign

01:34 - 48.676 individuals that have had an opportunity to review the campaign

01:34 - 50.566 versus those who have not

01:34 - 52.676 they're really

01:34 - 57.766 seeing the opioid epidemic as a serious problem and so when you compare the two

01:34 - 02.086 groups seventy five percent of the respondents who viewed the campaign versus those

01:35 - 07.666 that did not we really are seeing the opioid epidemic as a serious problem

01:35 - 11.416 eighty five percent of the respondents who reviewed the campaign agree that

01:35 - 14.656 they would be willing to provide in a locked zone to family

01:35 - 16.366 members and friends

01:35 - 19.366 and we also do know that

01:35 - 20.666 for those

01:35 - 22.826 who view the campaign.

01:35 - 27.154 They are really saying that it's important that employers

01:35 - 31.316 should not be allowed to deny employment for a person.

01:35 - 34.212 Taking medications for opioid use disorder and so

01:35 - 37.856 our goal is to continue to spread the message that

01:35 - 40.606 recovery is possible that there is hope

01:35 - 44.566 we're using social media we're using people with lipstick experience

01:35 - 47.636 we have over three hundred and sixty influencers

01:35 - 49.396 that are spreading the word

01:35 - 52.317 and we're going to continue to uplift the message

01:35 - 55.666 that services are available and that their beers help.

01:35 - 58.676 Shut out to the social workers out there.

01:35 - 00.376 That is German

01:36 - 01.976 thank the gentleman.

01:36 - 04.786 Representative representative record

01:36 - 07.486 so i could share will try to keep this one short for you

01:36 - 09.406 secretary Davis Jones

01:36 - 11.656 i appreciate everything that diet app has been doing

01:36 - 13.876 of to help combat the opioid

01:36 - 15.406 opioid epidemic

01:36 - 16.756 there are few places

01:36 - 18.316 in this commonwealth that aren't

01:36 - 19.966 hit and touched by this

01:36 - 20.836 and

01:36 - 22.756 it's my understanding that

01:36 - 25.156 Adidas contracts currently use

01:36 - 27.226 a name brand new lock zone

01:36 - 29.566 and i know when a lot of folks go to

01:36 - 33.075 the pharmacy pharmacists will instead prescribed a

01:36 - 36.536 generic lower cost same effectiveness and efficacy.

01:36 - 42.346 But Pennsylvania i believe is the only major state that hasn't switched to a generic

01:36 - 46.456 and we're one of nine i think states that haven't switched to a generic

01:36 - 47.926 of analog zone

01:36 - 50.878 which could save millions of dollars or allow our appropriations

01:36 - 53.146 to go further and potentially even save more lives

01:36 - 56.066 is is this something that the dap is exploring.

01:36 - 58.996 Yeah so we're always exploring the cost at

01:36 - 01.606 the cost of our program we work closely with the

01:37 - 05.026 department of general service is to negotiate our contracts

01:37 - 10.036 and our goal is to always to try to get the cheapest rates as it's possible

01:37 - 13.426 so this is something that we continue to look at

01:37 - 17.626 i'm not sure if it's on an annual basis we do established contracts with

01:37 - 19.126 different vendors

01:37 - 20.206 have but

01:37 - 25.756 i can tell you that the goal is to always try to think about how we can get the best

01:37 - 28.126 price for the products that we are offering

01:37 - 30.206 or are we using a generic

01:37 - 32.536 and i need to look

01:37 - 33.545 i'm not sure

01:37 - 35.476 i don't beliefs i don't think so

01:37 - 36.226 and

01:37 - 38.396 that we just saw a price.

01:37 - 40.516 Ice reduction in the

01:37 - 44.786 in the actual in the locked zone and i do believe it could be from competition

01:37 - 47.516 from generic is the generic still cheaper.

01:37 - 49.972 I would that i would need to look at i believe

01:37 - 52.126 it is and and you know i would encourage you and

01:37 - 52.966 if you could

01:37 - 55.096 certainly follow up with me about when

01:37 - 58.272 where or when that contract is available again it's

01:37 - 01.316 it's an api opportunity for us in the commonwealth

01:38 - 06.286 to save money or make our dollar go further again these are lives that we can be saving

01:38 - 07.996 and if we have

01:38 - 10.186 generic opportunities out there

01:38 - 12.826 that have the same efficacy that that are that

01:38 - 15.436 can save lives it meets all the same standards

01:38 - 17.626 i would highly encourage us to use it

01:38 - 19.036 and so

01:38 - 21.166 with that mr chairman that's

01:38 - 23.836 all i have i yield back the balance of my time

01:38 - 24.796 good job sir

01:38 - 26.846 thank you.

01:38 - 29.666 I think the general representative can.

01:38 - 30.436 Thank you Sharon

01:38 - 32.356 Harris thank you

01:38 - 36.076 to both of our secretaries and for your apartment for all your hard work and

01:38 - 41.156 dr boger i just want to thank you for defending the need for safe staffing

01:38 - 42.256 in nursing homes

01:38 - 43.996 i think the question for all of us

01:38 - 47.396 is do we want a loved one to be in a facility

01:38 - 49.886 that does not have adequate staffing

01:38 - 54.506 and we know for example on the hospital route.

01:38 - 58.076 In Pennsylvania if we had just put California ahead.

01:38 - 00.716 Every day we would save three lives.

01:39 - 02.986 From unnecessary

01:39 - 03.526 from

01:39 - 05.026 from from from dying

01:39 - 05.956 because

01:39 - 08.146 we don't have safe staffing centers

01:39 - 09.916 here in the commonwealth i just want to see

01:39 - 12.436 you do you want to you know at any anything to

01:39 - 14.206 you know the importance of safe staffing

01:39 - 16.016 in our healthcare facilities.

01:39 - 18.236 At absolutely

01:39 - 20.276 safe staffing is.

01:39 - 25.486 It serves two roles one is patient safety but also of staff burnout and so we want to

01:39 - 29.806 make sure that all of our facilities have staffing that meet the needs of patients

01:39 - 30.796 but also

01:39 - 32.776 take care of the staff that are doing

01:39 - 35.956 really challenging work every day saving people's lives

01:39 - 37.456 and i will say a you know

01:39 - 39.136 hospitals and

01:39 - 43.486 healthcare facilities really care for very sick individuals right and who gets

01:39 - 45.856 admitted to the hospital now the acuity of care

01:39 - 47.116 is very high

01:39 - 50.906 and so we want to make sure that those people who are dealing with those stressful.

01:39 - 52.096 Jobs

01:39 - 52.546 i

01:39 - 53.416 have support

01:39 - 54.166 yeah

01:39 - 57.796 and in fact the research shows that the facilities actually

01:39 - 59.626 they don't suffer in fact

01:39 - 02.806 more nurses are likely to stay and health care providers

01:40 - 05.836 are likely to stay because they're not doing more than they can

01:40 - 07.336 and it

01:40 - 09.616 it actually it it doesn't causes

01:40 - 11.636 hospitals to have.

01:40 - 11.926 What

01:40 - 13.696 untoward effects so

01:40 - 16.196 wanted to just uplift that.

01:40 - 18.466 Wanted to talk a little bit about

01:40 - 21.226 hospital consolidations so we're seeing a

01:40 - 21.766 really

01:40 - 26.386 problematic trend with these private equity and for profit groups

01:40 - 28.796 that are buying up hospitals.

01:40 - 33.686 There was a recent gallup poll that showed that one in three Americans

01:40 - 36.326 are actually skipping meals

01:40 - 38.576 and other necessities

01:40 - 39.916 to afford healthcare

01:40 - 42.236 one in three Americans.

01:40 - 46.376 Meanwhile we have private equity firms and for profit corporations

01:40 - 50.156 that are making hundreds of millions of dollars

01:40 - 54.256 and the hospitals that they're buying and health facilities that they're buying

01:40 - 55.396 are struggling

01:40 - 58.076 because they they're extracting those profits.

01:40 - 00.466 We have legislation here in

01:41 - 02.956 Pennsylvania representative rask is leading it

01:41 - 03.946 and also

01:41 - 05.476 a co prime modern and

01:41 - 06.706 all i think all the

01:41 - 09.626 Democratic members in the Delaware county

01:41 - 13.216 delegation are co-sponsors as well are co prime sponsors on it

01:41 - 15.136 that we give the agee powers

01:41 - 18.803 to really rein in the abuses of these private air equity

01:41 - 22.036 when it comes to hospital mergers and consolidations

01:41 - 25.276 and acquisitions can you talk about the importance of

01:41 - 26.956 giving the agee that power

01:41 - 29.836 to rein in this abusive practices that we're seeing

01:41 - 31.886 with these for profit corporations.

01:41 - 38.326 Yeah you did such a good job explaining the situation thank you yeah we have seen

01:41 - 39.166 and

01:41 - 42.056 challenges around and.

01:41 - 44.458 Have for profit

01:41 - 46.858 and other challenges with our hats

01:41 - 49.888 Beckham we have our

01:41 - 52.618 hospital closures that have resulted from

01:41 - 54.038 and.

01:41 - 56.818 The

01:41 - 58.568 use of some.

01:41 - 00.818 Private equity related

01:42 - 01.928 purchasing.

01:42 - 04.658 The department's role really is.

01:42 - 07.648 Currently around licensing and permitting

01:42 - 09.338 but we do have.

01:42 - 10.108 The

01:42 - 13.618 would be thrilled to work with you around authority to assure we can

01:42 - 14.338 have this

01:42 - 16.468 the tools we need to enforce

01:42 - 20.218 and ensure like we have with the long term care facilities so with the long term care

01:42 - 23.308 facility legislation that was passed regulations that were passed

01:42 - 25.228 you know we can we examined

01:42 - 27.038 fiscal responsibility

01:42 - 29.777 and things like that so we would love to talk to you

01:42 - 32.458 about the responsibilities we can have and work with you

01:42 - 33.118 on.

01:42 - 35.788 How to make sure that we can review

01:42 - 41.142 the hospital and as well as they making sure we're bringing in.

01:42 - 43.438 Owners and operators that can

01:42 - 45.448 provide the services that they say

01:42 - 49.318 and that is they're there for the long term and provide quality of care and it's

01:42 - 50.938 important that we work together on that

01:42 - 53.108 because there are.

01:42 - 55.268 Certainly

01:42 - 58.918 hospital closures that we've seen and challenges we've seen over the last couple of

01:42 - 01.138 years that are impacting access to care

01:43 - 03.388 and we would like to work with you all to make sure that

01:43 - 05.348 continues to.

01:43 - 07.508 We continue to work together.

01:43 - 08.678 On that.

01:43 - 10.888 Yeah and all I'll just close close

01:43 - 12.598 close it out with what you're saying

01:43 - 15.028 we've actually seen this is a bipartisan issue

01:43 - 16.418 we've

01:43 - 20.288 and in the senate us senate Chuck grassley

01:43 - 24.718 and white house working working together calling out some of these really bad actors

01:43 - 27.658 Apollo global management prospect medical

01:43 - 29.578 we saw what happened in Chester county the

01:43 - 31.358 closing of this hospitals.

01:43 - 32.368 So

01:43 - 32.818 yeah

01:43 - 35.668 i know that it's an issue for the governor as well that he's

01:43 - 37.558 interested in making sure that we

01:43 - 38.278 do

01:43 - 39.148 bringing

01:43 - 40.198 operators

01:43 - 42.068 that will be reliable

01:43 - 45.148 and provide quality of care for all Pennsylvania so we

01:43 - 46.978 we do need to work on this together

01:43 - 50.858 to make sure we have all the tools we can to ensure that.

01:43 - 51.838 Thank you thank you chairman

01:43 - 52.708 digital man

01:43 - 54.058 representative and so

01:43 - 55.588 thank you chairman Harris

01:43 - 57.388 and thank you all for being here today

01:43 - 00.999 my question goes to a secretary Davis Jones.

01:44 - 03.308 On the open your settlement.

01:44 - 07.168 Secretary Pennsylvania is expected to receive nearly two billion dollars

01:44 - 08.848 from the opioid settlement

01:44 - 09.898 agreements

01:44 - 13.928 with about seventy percent going directly to the counties and local governments.

01:44 - 17.758 These funds are meant to address the damage caused by the opioid crisis

01:44 - 19.138 secretary back ak

01:44 - 22.738 two years ago i was at a night out and one of my communities

01:44 - 26.338 and my daughter come up to me at the end of the night and there was a bag full of candy

01:44 - 28.558 and in that bag was a

01:44 - 29.428 an

01:44 - 30.818 inhaler.

01:44 - 34.388 And so is that.

01:44 - 35.188 What

01:44 - 37.288 i guess my question is what oversight

01:44 - 39.398 does a commonwealth have

01:44 - 40.468 to

01:44 - 42.308 to make sure that.

01:44 - 44.338 You know would justice nor can

01:44 - 47.428 is that a good use of the nork in a bag with a rishi cup

01:44 - 49.418 going out to the kids

01:44 - 51.508 tonight i gave it to our local police chief

01:44 - 55.078 and he took it back and i really didn't dive into this trust fund

01:44 - 58.048 until shortly after this so could you just touch on what

01:44 - 59.488 i guess what oversight it

01:44 - 01.598 you have over it.

01:45 - 05.757 So i think you you're asking you you talked about an experience that your daughter

01:45 - 08.068 had i guess and naloxone with a tree

01:45 - 09.988 and in a bag and

01:45 - 11.068 is it

01:45 - 12.628 from your perspective that

01:45 - 15.158 that product came from.

01:45 - 17.488 The opiate settlement funds yeah

01:45 - 18.178 yes

01:45 - 19.931 well i can tell you that

01:45 - 23.078 currently here in the commonwealth we use

01:45 - 27.238 our state opioid response funds to

01:45 - 30.848 support our overdose prevention

01:45 - 31.768 program

01:45 - 34.868 we have one hundred partners across the commonwealth

01:45 - 37.598 and we try to ensure that

01:45 - 38.968 naloxone

01:45 - 41.188 brand name narcan gets into the

01:45 - 44.008 hands of those that need it the most

01:45 - 48.358 why was it a treat bag for a kid is unbeknownst to me

01:45 - 50.578 and you know i don't know how

01:45 - 51.688 that would be the case

01:45 - 52.928 however

01:45 - 55.078 the the goal is to

01:45 - 56.608 always target

01:45 - 59.998 and ensure that we're getting naloxone

01:46 - 02.668 in the hands of those that are at highest risk

01:46 - 03.118 for

01:46 - 04.048 overdose

01:46 - 07.368 and then also ensuring that Amalie members and

01:46 - 10.228 loved ones or anyone else within perhaps someone's

01:46 - 12.667 social network can have access to it as well

01:46 - 15.358 because as you know an individual can't use

01:46 - 17.228 naloxone on themselves

01:46 - 20.368 it has to be someone that's witnessing the overdose

01:46 - 21.758 so again.

01:46 - 26.848 From the process active of what oversight do we have and there is the opiate trust

01:46 - 31.438 who has the responsibility of monitoring those funds that are

01:46 - 34.713 distributed to the counties which is eighty five percent

01:46 - 37.558 of the funds and in the fifteen percent that comes to us

01:46 - 40.138 so again we're not using it and if

01:46 - 42.838 a county i would like to purchase as

01:46 - 47.218 an naloxone that is a permissible use under exhibit ii

01:46 - 49.808 for counties to use.

01:46 - 52.108 You know to use those funds for

01:46 - 56.938 but again about it being in a bag or being given to children and

01:46 - 58.118 yet.

01:46 - 59.668 I can't really speak to that

01:46 - 00.208 yeah

01:47 - 00.808 so

01:47 - 03.118 talk about the structure a little bit

01:47 - 05.668 the seventy percent goes to the counties

01:47 - 09.418 the counties have the sole discretion to dispense that seventy percent

01:47 - 12.278 or to some of those have to come back to the trust.

01:47 - 13.108 Know

01:47 - 15.838 the counties in litigating subdivisions which

01:47 - 18.658 is equivalent to eighty five percent of those open

01:47 - 19.678 settlement funds

01:47 - 24.058 it is up to the county to decide how to use those fine as long

01:47 - 25.258 as they are and

01:47 - 26.818 i'm alignment with exhibit

01:47 - 32.188 e now what the trust has the ability to do as every single year the trust

01:47 - 33.628 will review

01:47 - 35.698 how those funds are spent

01:47 - 39.178 and then their trust will say whether or not those

01:47 - 42.628 activities are allowable are disallowed

01:47 - 44.428 and if disallow then

01:47 - 47.758 the county will owe back those funds or will not be

01:47 - 49.108 given those funds in the

01:47 - 49.798 next

01:47 - 50.728 fiscal

01:47 - 51.538 year

01:47 - 52.318 okay

01:47 - 55.288 i get a lot of questions orders from our police chiefs back in the

01:47 - 56.698 back of my district so

01:47 - 59.668 his era i know the last time i went on a website

01:47 - 03.328 we could see what grants were awarded some of the expenditures but it was

01:48 - 05.815 it wasn't year to year it was like all the way

01:48 - 08.008 back from twenty three twenty four i believe

01:48 - 09.058 is there a way that

01:48 - 11.698 is there a report out there that we could have access to were

01:48 - 13.018 some of the expenses for the

01:48 - 14.668 settlement funds yeah

01:48 - 20.578 if you go to the opioid trust website there's lots of information that shares

01:48 - 24.028 what is happening within the counties the funds spent

01:48 - 25.198 so it's

01:48 - 28.443 i don't have the website off and but there

01:48 - 33.968 there is a website that really is detailed and shares lots of information

01:48 - 34.768 about

01:48 - 36.998 how those funds are expended.

01:48 - 37.408 All right

01:48 - 40.163 i have one more question but i'm going to submit it for

01:48 - 43.568 the timer so chairman hey look at that smile right there.

01:48 - 45.178 Thank the gentleman

01:48 - 48.238 representative Webster chairman thank you

01:48 - 48.718 and

01:48 - 49.868 secretary

01:48 - 52.418 secretary thank you both for being here.

01:48 - 55.588 It is late in the afternoon and but

01:48 - 55.960 i

01:48 - 57.358 guess we're getting a little

01:48 - 59.198 carried away.

01:48 - 00.698 Previously

01:49 - 01.348 then I'll

01:49 - 03.208 appoint two chairs in front of me here

01:49 - 04.018 and

01:49 - 04.618 my

01:49 - 05.758 female colleague

01:49 - 07.438 would let you know every time that

01:49 - 08.578 she's a nurse

01:49 - 10.238 and she's from Scranton

01:49 - 10.738 i

01:49 - 11.818 am not a nurse

01:49 - 13.318 my mother was a nurse

01:49 - 15.898 for thirty eight years in the maternity ward

01:49 - 17.968 and rocks from memorial hospital and

01:49 - 19.408 and so we talk about

01:49 - 21.448 the other nurse in the room and

01:49 - 24.088 and his area of Philadelphia today

01:49 - 27.748 i think that leads and i'm just sort of endorsing what you know you

01:49 - 30.058 the support you have for nurses

01:49 - 32.678 for the workforce issue and stipends.

01:49 - 33.928 For

01:49 - 35.108 maternal.

01:49 - 36.178 Issues like

01:49 - 40.138 that maternity ward at roxboro hospital doesn't exist any longer

01:49 - 41.368 it was

01:49 - 42.508 bought and sold

01:49 - 44.308 the hospital we know those issues

01:49 - 46.868 so so i'm refocusing

01:49 - 49.018 on that private equity is

01:49 - 50.458 equity issue and

01:49 - 52.508 want to talk about that a little bit.

01:49 - 53.911 I

01:49 - 56.198 was at a conference this summer

01:49 - 57.428 with

01:49 - 59.308 the attorney general's

01:49 - 02.968 from Massachusetts from new York and from Rhode island

01:50 - 04.808 and their.

01:50 - 07.558 Their strongest recommendation was

01:50 - 10.478 make sure the attorney general in Pennsylvania

01:50 - 11.698 has the authority

01:50 - 13.228 to evaluate these

01:50 - 14.968 acquisitions and mergers

01:50 - 18.208 is that something that you support as a department

01:50 - 18.898 for

01:50 - 20.348 for Pennsylvania.

01:50 - 25.318 Again i think you know the governor has talked about how important it is that as

01:50 - 25.738 a

01:50 - 26.158 and

01:50 - 29.378 state that we can make sure that we have.

01:50 - 31.528 Operators of our healthcare facilities

01:50 - 32.518 that are committed

01:50 - 33.598 to the community

01:50 - 37.798 and that they put the patients before profits and so i think

01:50 - 41.188 we need to do all that we can to make sure that we have the tools

01:50 - 42.328 in our tool box

01:50 - 44.518 to make sure that that happens

01:50 - 48.308 so happy to talk to you and anyone about how we can.

01:50 - 50.668 Work together to ensure that we

01:50 - 52.798 have the controls that we need

01:50 - 54.298 the tools that we need

01:50 - 55.688 to ensure

01:50 - 57.784 that our providers are doing what they need to do to

01:50 - 00.788 take care of patients and not abandon them and leave.

01:51 - 01.408 Them

01:51 - 01.738 i'm

01:51 - 03.458 covered for care.

01:51 - 05.908 My my understanding as as we sort of.

01:51 - 08.008 Peel back the onion right

01:51 - 08.519 that

01:51 - 12.298 these private equity firms are now moving into specialty practices

01:51 - 14.698 in oncology and gastrointestinal

01:51 - 15.938 practices

01:51 - 18.238 and and they're so cash rich that they're

01:51 - 20.618 they're buying up these other.

01:51 - 21.418 Pieces

01:51 - 24.188 and and i know in Montgomery county Pennsylvania

01:51 - 25.408 there's really only one

01:51 - 27.308 gastro intestinal.

01:51 - 29.008 Community you can go to

01:51 - 33.028 so it becomes a monopoly system rather than a service

01:51 - 34.148 system.

01:51 - 38.338 Are you tracking those same kinds of things through the department or

01:51 - 40.288 are seeing trends in those ways

01:51 - 41.608 so the department

01:51 - 44.008 oversees the licensure of facilities

01:51 - 46.438 we don't oversee the license for a

01:51 - 50.968 private practices write those really fall under the individual physician license

01:51 - 53.038 which falls under the department of state

01:51 - 54.398 so.

01:51 - 58.392 Track practice specifically around

01:51 - 00.612 access the other issue is that the

01:52 - 02.322 insurance commissioner and

01:52 - 04.462 does some work on adequacy.

01:52 - 07.092 Issues to making sure there's adequacy of

01:52 - 11.962 services but that doesn't really fall to the department of health around

01:52 - 15.972 individual like for instance a dermatology practice or a pediatric pra cactus

01:52 - 19.542 that falls under the department of state under the physician license

01:52 - 20.772 we really license

01:52 - 23.946 hospitals ambulatory surgical facilities long-term

01:52 - 27.202 care skilled nursing facilities and the like.

01:52 - 28.032 Im

01:52 - 32.532 sorry if i can just add that there are some instances where there are outpatient

01:52 - 35.082 facilities associated with a hospital license

01:52 - 37.452 in addition to what the secretary said so

01:52 - 41.772 there could be a case where you know there's a closure of a hospital that also had

01:52 - 46.512 outpatient facilities that also close and i think to your point about you know

01:52 - 48.492 oversight from the attorney general his office

01:52 - 50.692 the department of health has oversight

01:52 - 54.462 of the operators and we regulate the operators but

01:52 - 55.602 we can look at

01:52 - 58.432 the ownership structure within that framework

01:52 - 03.342 and look at the finances in that sense when there's murders or change of ownership but

01:53 - 06.342 are are thirty only go so far so we can't

01:53 - 09.372 control really the owner presence acer with me to hear that

01:53 - 10.002 my

01:53 - 11.562 i'm thinking immediately that

01:53 - 13.242 we're looking at some

01:53 - 15.712 sort of systemic issues that.

01:53 - 18.132 I mentioned nurses when we started writing

01:53 - 20.052 you have nurses

01:53 - 20.292 a

01:53 - 23.802 department of education has nurses or department of corrections as nurses

01:53 - 25.842 and i'm not sure we're looking at it.

01:53 - 28.842 As as a workforce issue across the board

01:53 - 31.422 in this case with the private equity things

01:53 - 34.902 government is not prepared because we have licensing and

01:53 - 35.356 and

01:53 - 38.022 authorities in different places and it sounds like we need to

01:53 - 38.652 think

01:53 - 39.982 i will.

01:53 - 40.668 The

01:53 - 43.182 governor really is thinking across all of

01:53 - 44.832 you know working together

01:53 - 46.072 so.

01:53 - 49.672 Kristin's point is right many.

01:53 - 53.442 Outpatient facilities are part of our fall under a hospital license that would fall

01:53 - 55.552 to us so i appreciate that clarification

01:53 - 58.254 and that clarification i think Kristin's point

01:53 - 00.492 really as operators and owners are different

01:54 - 01.422 and

01:54 - 04.342 we need to make sure that as you consider your.

01:54 - 07.212 Options around authority and control

01:54 - 09.532 to make sure that we consider.

01:54 - 11.922 What we can do around

01:54 - 13.512 that difference and

01:54 - 15.832 to really make sure people understand

01:54 - 16.752 the difference

01:54 - 20.562 and i know it's not simple but we appreciate all the effort we can get to

01:54 - 21.492 to

01:54 - 22.332 provide

01:54 - 25.402 health and medical services rather than.

01:54 - 30.012 No business transactions and i would be remiss if i didn't do a shout out for nurses

01:54 - 32.107 too since my mother-in-law's a nurse at my sister-in-law's

01:54 - 34.792 a nurse and i have a daughter who's a nurse.

01:54 - 35.592 So yes

01:54 - 37.372 shout out to the nurses.

01:54 - 39.112 Annulment.

01:54 - 41.682 Thank you chairman Harrison

01:54 - 42.252 sorry i

01:54 - 45.832 can't shout out that i don't have any family members that are nurses.

01:54 - 46.932 Wish i did

01:54 - 49.882 they take good care of you that's what i can say their caregivers.

01:54 - 53.594 Madam secretary i'd like to direct you to attention to

01:54 - 56.352 a page age thirty seven the governor's executive budget

01:54 - 00.412 which shows the emergency medical services operating fund.

01:55 - 04.602 Beginning in the current fiscal year an additional six million dollars is transferred

01:55 - 07.722 to your department for disbursement to regional economists councils

01:55 - 10.672 for recruitment and retention efforts

01:55 - 14.032 are you drawn down on that cash balance for the account.

01:55 - 17.562 Are you drawing down on the cash balance of that account

01:55 - 19.432 to fund this effort.

01:55 - 21.102 Yes

01:55 - 22.662 the m soft fund

01:55 - 25.962 had accumulated more money in its account

01:55 - 28.582 due to increases in.

01:55 - 30.282 The collection of

01:55 - 33.612 fees and we wanted to make sure that money gets back out and is used

01:55 - 37.312 so we are using those funds to fund.

01:55 - 41.782 A number of projects related to it goes through the regional councils

01:55 - 46.005 to the agencies to do workforce recruitment and education

01:55 - 47.442 and equipment yes

01:55 - 50.150 it appears that the the ending cash balance of the account

01:55 - 52.362 at the end of the fiscal year twenty six twenty seven

01:55 - 54.792 would be approximately nine point eight million

01:55 - 58.032 do you plan to continue this initiative through twenty seven twenty eight.

01:55 - 02.382 Ah yes we have it in the propose the budget for this year and it was originally a

01:56 - 06.042 three year spend down to make sure that the money could be used most effectively

01:56 - 08.040 and we've been working really closely with the

01:56 - 10.122 regional councils on what that should look like

01:56 - 11.052 and

01:56 - 15.282 and i'm really happy to say i was just out in allegheny county at an event

01:56 - 17.562 and talking about how for instance

01:56 - 20.907 one of the gms west was using it to distribute

01:56 - 24.192 and make sure that all of the ambulances that have

01:56 - 25.842 a ls can use it

01:56 - 27.462 a video laryngoscope

01:56 - 29.832 which is actually a really amazing tool

01:56 - 31.092 to make sure that people

01:56 - 32.712 improve first-pass

01:56 - 34.182 intubation techniques

01:56 - 35.142 and they are

01:56 - 39.196 have an equitable way they're purchasing and distributing those and making sure all

01:56 - 42.672 of the ambulances that are across the entire gms west

01:56 - 43.332 footprint

01:56 - 44.922 have these tools so

01:56 - 46.572 that's an example of how

01:56 - 48.402 some of that funds have been used

01:56 - 51.532 by just sept just one regional council but it

01:56 - 54.562 is important that this money be distributed

01:56 - 58.342 over time so that they can get it out and used most effectively.

01:56 - 00.398 I was going to ask what the allowable uses was for

01:57 - 02.442 this funding but i think you've covered some of that

01:57 - 06.672 do you have any metrics on the data to prove that this funding has been successful

01:57 - 08.622 in these efforts and again i think if

01:57 - 09.972 we're talking about the western

01:57 - 10.962 are getting those

01:57 - 12.522 those pieces of equipment out

01:57 - 14.752 it certainly is working.

01:57 - 16.032 The auditor general

01:57 - 18.768 Tim de flore released a performance audit of the emergency

01:57 - 20.832 medical services operating fund in November of two

01:57 - 21.642 twenty five

01:57 - 24.012 the fire department failed to adequately monitor

01:57 - 26.232 the emergency medical services operating fund

01:57 - 29.472 and failed to strengthen the initial controls identified

01:57 - 30.972 in the previous audits

01:57 - 33.295 specifically sixty eight percent of the expenditures

01:57 - 35.352 lack the supporting documentation needed

01:57 - 39.186 to verify funds that were spent for allowable purposes

01:57 - 42.312 has your department contacted or corrected these issues

01:57 - 45.612 and are going to be sure that the new retention and recruitment funding

01:57 - 47.662 will be spent appropriately.

01:57 - 51.792 Thank you i really appreciate the opportunity to talk about this important fund

01:57 - 54.481 so i just want to be clear i know there have been some

01:57 - 57.522 reports out there that money is missing no money is missing

01:57 - 00.072 every penny went out to the regional councils

01:58 - 02.812 and their issue was really around documentation

01:58 - 06.462 so i'd like to give you a brief history so when i arrived as a secretary of health

01:58 - 08.232 in twenty twenty three

01:58 - 12.972 i receive shortly after my arrival the m south audit which is required by law

01:58 - 17.682 for the twenty eighteen to twenty one year so it's a two year delay in the audit

01:58 - 21.199 i received that in i think march or so roughly

01:58 - 22.242 twenty twenty three

01:58 - 24.792 and i met with our team right away Kristen and i

01:58 - 25.689 and

01:58 - 29.322 our deputy went out to all the regional councils to have discussions figure out what

01:58 - 31.272 was going on and really we put in place

01:58 - 32.352 a response

01:58 - 33.042 to

01:58 - 36.402 the audit as well as to really repair the

01:58 - 40.452 challenges that were between the department and the regional councils and that's been

01:58 - 44.452 fixed which is great we're working really well with the regional councils

01:58 - 45.162 so

01:58 - 48.042 by the end of two thousand and twenty three we had in place

01:58 - 49.782 fiscal management that we

01:58 - 54.222 developed new software for tracking we had worked with the regional councils on

01:58 - 56.952 implementing it we implemented all the training

01:58 - 58.062 and that happened over

01:58 - 01.632 the year and by the end of two thousand twenty four where everything was in place

01:59 - 04.392 the problem is that the next audit that was done

01:59 - 08.122 covered twenty twenty one to twenty twenty four.

01:59 - 12.522 So two years of which i had no ability to make any change to the prior audit

01:59 - 15.102 and so i'm thrilled to tell you that

01:59 - 17.415 we will not see these challenges again because

01:59 - 19.632 we've addressed all of the issues in the audit

01:59 - 22.992 and over the last couple of years and we have in place

01:59 - 25.662 really careful control measures again

01:59 - 29.862 no money is missing it was just really a documentation issue and we have resolved

01:59 - 32.502 all of the challenges around documentation so i am

01:59 - 36.432 confident that our next m sof report which will reflect the time

01:59 - 38.592 that we have been addressing the issues

01:59 - 41.742 will not reflect the same challenges and it's been really

01:59 - 45.042 our pleasure to work with a regional councils i want to give a shout out to them

01:59 - 46.542 because they've been great to work with

01:59 - 50.202 they all understand the challenges that we are faced and they

01:59 - 53.112 appreciate that we are working on this together

01:59 - 56.592 so thank you for the opportunity to talk about that i appreciate that i'm a big

01:59 - 59.280 supporter of rpms and i want to make sure that they're getting their

01:59 - 00.102 funding do

02:00 - 01.002 thank you thank you

02:00 - 01.662 so much

02:00 - 05.062 thank the gentleman representative Flemming.

02:00 - 08.752 Thank you mr chairman good afternoon.

02:00 - 10.332 Doctor bogan dr

02:00 - 13.792 David Jones thank you very much for giving us your time.

02:00 - 16.672 I want to talk about something that is.

02:00 - 20.272 Really pertinent to my family as well as.

02:00 - 23.202 Thousands of other families across the commonwealth and that's

02:00 - 24.852 the school health services

02:00 - 26.661 reimbursed i meant.

02:00 - 31.692 That reimbursement has remained flat funded since nineteen ninety one

02:00 - 35.742 while the number of students with complex medical needs chronic conditions

02:00 - 39.082 and behavioral health challenges has increased significantly

02:00 - 40.242 including you know

02:00 - 41.142 our daughter

02:00 - 46.722 who I've spoken about many times she's a type one diabetic and so that condition

02:00 - 48.702 requires management throughout the day

02:00 - 50.772 throughout the week at all times

02:00 - 54.142 and often times she is changing.

02:00 - 56.922 Her cgm or changing her pot at school

02:00 - 01.012 with the assistance of a wonderfully competent and capable

02:01 - 02.082 middle school nurse

02:01 - 05.292 and so i am grateful for school health service

02:01 - 07.602 is that are provided i'm grateful that.

02:01 - 10.902 You know my home school district does invest in

02:01 - 12.082 robust

02:01 - 13.602 school nursing care

02:01 - 15.552 throughout each of it's buildings

02:01 - 18.282 i know this isn't the reality for everybody else so

02:01 - 22.482 i couldn't the department quantify the gap between the current state

02:01 - 25.932 reimbursement and the actual cost to school entities

02:01 - 28.007 to provide these services.

02:01 - 30.112 Yes i appreciate

02:01 - 33.822 that and again other shadow to narcisse and the importance of nurses in our

02:01 - 38.602 health care system including in our schools so as you alluded to.

02:01 - 41.239 We do have a school many schools have school

02:01 - 43.842 nurses but we know that there are not enough

02:01 - 45.774 it's been about thirty five years since the

02:01 - 48.562 reimbursement rates have really been updated

02:01 - 49.152 and

02:01 - 50.934 you think the other really important point is

02:01 - 53.542 that the number of students in our schools.

02:01 - 57.284 That need nursing services a complex nursing services

02:01 - 00.462 like diabetes management seizure management and

02:02 - 02.532 a variety catheterization

02:02 - 05.232 concussion monitoring blood pressure monitoring

02:02 - 06.432 i know i certainly sent my

02:02 - 08.318 and many of my students

02:02 - 11.738 with prescriptions to the school nurses to monitor things like blood pressure

02:02 - 14.358 and those have really increased

02:02 - 17.367 and when you compare twenty fifteen sixteen

02:02 - 20.258 school year to twenty twenty three twenty four

02:02 - 24.638 we've seen a sixty six percent increase in students needing complex care

02:02 - 25.998 for nurses

02:02 - 30.338 with a a three point eight percent decrease in the total number of students

02:02 - 32.178 so we're seeing.

02:02 - 34.698 Fewer students but more complexity

02:02 - 35.513 and

02:02 - 38.378 really our reimbursement has not kept up with that need

02:02 - 39.738 so.

02:02 - 43.898 I think we have seen about a thirty one percent decrease in the amount of overall

02:02 - 47.148 cost coverage in that time period as well.

02:02 - 47.858 So

02:02 - 48.848 would love to

02:02 - 51.130 consider in figure out how we make sure that

02:02 - 53.618 our students that are relying on these services

02:02 - 55.808 have school nurses available to them

02:02 - 59.708 and again funding is is definitely a challenge and reimbursement so

02:03 - 02.718 again important discussion we all need to have

02:03 - 07.788 and we will absolutely do so i think you know there's there's nothing more.

02:03 - 11.868 Fundamentally important than making sure that.

02:03 - 12.848 Students

02:03 - 16.111 can access healthcare while at school and

02:03 - 20.138 then the last thing i want to say is for doctor Davis Jones

02:03 - 22.608 i really appreciate your.

02:03 - 25.718 Presence in the capital region

02:03 - 28.819 I've been privileged to attend to number of events

02:03 - 31.988 where the department of drug and alcohol services

02:03 - 32.498 or the

02:03 - 34.328 department of drug and alcohol programs

02:03 - 34.988 is

02:03 - 36.878 in hit here in the capital region

02:03 - 39.338 and your partnership with the dauphin county

02:03 - 41.148 drug and alcohol

02:03 - 42.398 department is

02:03 - 45.398 really top notch so i just want to say thank you so much

02:03 - 47.340 for the work that you're doing across the state

02:03 - 49.238 but particularly here in the can capital region

02:03 - 51.730 and thank you for the naloxone for my office

02:03 - 54.175 we've actually distributed three cases or

02:03 - 59.378 three three doses in my district office since i saw you a couple of years ago

02:03 - 02.378 and was able to get that from you so thank you so much

02:04 - 03.578 thank you mr chairman

02:04 - 06.248 thank the gentleman representative medicine

02:04 - 09.008 alright i have a very quick question and.

02:04 - 10.658 Basically i'm just

02:04 - 11.138 a

02:04 - 14.328 first of all good afternoon and thank you so much for coming today

02:04 - 15.038 and

02:04 - 16.505 answering all your questions and thanks for all

02:04 - 18.678 you do for the commonwealth of Pennsylvania.

02:04 - 24.488 I just want to piggyback off of chair frankel's a question or statement regarding the

02:04 - 26.868 high efficiency air purifiers.

02:04 - 29.578 I'm actually very interested in working with

02:04 - 31.868 my folks in my district to make sure that they

02:04 - 33.158 acquire these

02:04 - 36.938 so how is the best way or what are the next steps we can take to make sure that

02:04 - 40.448 everybody in our district has an opportunity we want to sit court you and getting

02:04 - 42.278 these out and making sure that our

02:04 - 43.148 and

02:04 - 46.368 this this technology is being used throughout our districts

02:04 - 46.808 and

02:04 - 50.648 yes i appreciate that you know again this was a process we went through

02:04 - 52.118 over a couple of years

02:04 - 52.778 of

02:04 - 55.658 reading lists reaching out to people we reached out to other

02:04 - 58.268 folks on the list multiple times of their interest

02:04 - 59.108 and

02:04 - 01.178 that the money is and

02:05 - 02.648 i have to get back to you on

02:05 - 06.008 and how much more time we have to get that funding out

02:05 - 07.958 of the UK and

02:05 - 11.388 will work with you after the hearing to make sure we.

02:05 - 13.508 Provide information we can about where

02:05 - 15.548 what left what we have left to do to

02:05 - 17.178 get this.

02:05 - 20.708 Absolutely and if there was nobody in my district that got back to you i just want to

02:05 - 22.628 follow up with them personally just to make sure

02:05 - 23.768 that they let you know

02:05 - 26.048 and they're not missing out i appreciate that.

02:05 - 27.758 Thank you that was it

02:05 - 29.268 thank you

02:05 - 29.906 and thank you.

02:05 - 32.508 For that mean for the kind work.

02:05 - 34.158 Like the gentleman

02:05 - 35.318 chairman druzy

02:05 - 37.118 thank you chairman Harris swab

02:05 - 40.148 just wrap things up i appreciate y'all being here

02:05 - 41.288 appreciate

02:05 - 43.928 the secretary coming out to Indiana for the

02:05 - 46.088 rural healthcare conference back in the fall

02:05 - 48.588 along with secretary are kush.

02:05 - 49.418 No i

02:05 - 50.198 really

02:05 - 51.318 do.

02:05 - 53.318 I think we highlight a lot of stuff today

02:05 - 55.818 we clearly have challenges in healthcare

02:05 - 57.368 particularly in rural areas

02:05 - 58.208 but i

02:05 - 01.328 also believe that working together we can find solutions

02:06 - 01.954 so

02:06 - 03.518 i think it's important that you

02:06 - 05.528 do come out to the rural areas that we

02:06 - 10.118 we talk about solutions not necessarily pointing fingers but working together

02:06 - 15.158 to collaboratively ap approach new and innovative ways to make sure that people are

02:06 - 18.638 getting healthcare in every corner of this commonwealth so i appreciate

02:06 - 22.628 all that you do i appreciate our first responders our health care workers

02:06 - 26.168 and everyone out there that's taking care of of those in need

02:06 - 27.788 and then to wrap things up

02:06 - 29.838 for these budget hearings.

02:06 - 33.848 Chairman heresy i appreciate your flexible city with the speakers throughout these

02:06 - 35.928 two and a half weeks i guess.

02:06 - 38.233 Through all of these hearings i appreciate that as a

02:06 - 41.658 referee you did not actually throw the flag at anyone.

02:06 - 44.302 And

02:06 - 44.678 as

02:06 - 48.008 we all understand it it's been a long long

02:06 - 49.578 journey

02:06 - 53.978 but we also understand that this is the next step in the process of working together

02:06 - 56.138 to create a budget for this commonwealth

02:06 - 57.438 that.

02:06 - 01.508 Is responsible with taxpayer dollars but also meets the needs

02:07 - 04.508 of all our constituents and the people of this commonwealth

02:07 - 08.678 and hopefully we can get that done by June thirtieth so thank you all for being here

02:07 - 11.118 thank you to all the committee members although.

02:07 - 13.428 Not many are left we appreciate

02:07 - 16.268 your commitment as well and and the staff

02:07 - 17.828 there's a lot that goes on

02:07 - 21.398 not just in these hearings but behind the scenes and we appreciate everyone's

02:07 - 23.588 commitment to this process zest because it is

02:07 - 25.748 important and it is for

02:07 - 28.328 the people of this great great state

02:07 - 29.048 thank you

02:07 - 31.208 thank the gentlemen and i

02:07 - 32.538 think.

02:07 - 33.878 Secretaries

02:07 - 37.008 bogan and Davis Jones were being here.

02:07 - 38.838 For the work that you do.

02:07 - 40.658 For the thirteen million or so

02:07 - 43.402 people that live in this commonwealth and all of

02:07 - 46.248 the staff and all of the folks at the departments

02:07 - 47.228 that you lead

02:07 - 49.118 i do want to echo

02:07 - 51.648 the chairman's sentiments i'd think.

02:07 - 53.348 You know we have

02:07 - 59.058 different ideologies or policy disagreements and that's fine.

02:07 - 02.088 I honestly believe that a healthy

02:08 - 03.828 and.

02:08 - 06.708 A healthy government is one with political.

02:08 - 07.998 Discourse

02:08 - 12.078 and you can be you can disagree without being disagreeable

02:08 - 17.528 and far too often our body politic today i think we don't see enough of it so

02:08 - 20.748 I'll try my best over the last two weeks

02:08 - 23.558 to give everyone room room to

02:08 - 25.838 share their perspective extra questions

02:08 - 29.528 but do so in a way that was respectful to the dignity of the chamber

02:08 - 31.778 and of the work that we do and i hope that we

02:08 - 33.678 achieve that goal

02:08 - 34.998 and.

02:08 - 38.058 I hope that the people of the commonwealth

02:08 - 39.378 do.

02:08 - 43.608 If you don't have anything to do and you can't go to sleep at night.

02:08 - 45.738 Go back and watch the budget.

02:08 - 49.308 You actually will learn a lot.

02:08 - 52.608 No seriously though over the last.

02:08 - 53.738 Few days few weeks.

02:08 - 55.088 We've had

02:08 - 56.588 experts in their field

02:08 - 57.368 come of

02:08 - 59.858 a front of this committee and answer questions on

02:09 - 01.508 the dollars and cents

02:09 - 05.778 the taxpayer dollars assistant will be expected expended.

02:09 - 08.678 For the benefit of the people of this commonwealth so

02:09 - 10.428 i am grateful.

02:09 - 12.278 For all of the work of the committee

02:09 - 15.828 committee members the staff the staff from the agency's

02:09 - 17.508 staff from the administration.

02:09 - 20.648 As we embark upon this next part

02:09 - 22.058 of the budgetary

02:09 - 22.628 journey

02:09 - 24.528 and with that.

02:09 - 27.708 Budget hearings of twenty twenty six.

02:09 - 30.288 Are now closed thank you everybody.

02:09 - 59.858 I.