House Committee on Health and Human Services (02/22/2010)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/22/2010	ATTENDANCE

Time:	01:31 PM to 07:01 PM	Acree	X
		Apuan	*
Place:	LSB A	Gerou	X
		Kefalas	X
This Meeting was called to order by		Kerr J.	X
	Representative Riesberg	Primavera	X
		Roberts	X
This Report was prepared by		Swalm	X
	Kelly Stapleton	Tyler	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB10-1033 HB10-1224 HB10-1226 HB10-1283 HB10-1216		Referred to Appropriations Amended, Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Judiciary Amended, Referred to the Committee of the Whole

01:32 PM -- House Bill 10-1033

Representative Riesberg explained that the House Bill 10-1217, which was printed first on the calendar, was laid over to March 1, 2010. Representative Massey presented House Bill 10-1033 which was recommended by the Health Care Task Force. He stated that the bill adds screening, brief intervention, and referral for treatment for substance abuse (SBIRT services) to the list of optional services covered by Medicaid.

01:35 PM -- Dr. Kerry Broderick, SBIRT Colorado and Denver Health, spoke in support of the bill. Dr. Broderick spoke to her experience working in an emergency room identifying individuals with substance abuse problems. She explained how screening individuals early on, giving feedback, and helping change behavior saves state health care dollars. She stated that emergency room visits are not an efficient way of managing substance abuse issues. She stated that there is concrete evidence which shows that prevention saves money and lives.

01:38 PM -- Leigh Fischer, Program Manager, SBIRT Colorado Initiative, spoke in support of the bill. She read the testimony in support of the bill from Carolyn Swenson. She referred to a handout regarding clinical guidelines which recommends the SBIRT model (Attachment A). She stated that evidence illustrates that a brief intervention reduces the risk of individuals developing substance abuse addiction.

01:43 PM -- Dana Abbey, Medical Librarian, University of Colorado, and representing Colorado Public Health Association, spoke in support of the bill. Ms. Abbey detailed several statistics to the committee regarding drug addiction. She stated that for every $100 spent on substance abuse addiction, $3 goes towards prevention and treatment and $97 deals with the consequences of substance abuse, such as uncompensated care to hospitals or costs to the judicial system. She stated that approximately $1.7 billion of the state's budget is spent on substance abuse. Ms. Abby stated that reducing substance abuse has positive effects on public health.

01:47 PM -- Dr. Brett Kessler, Colorado Dental Association, spoke in support of the bill. He described a situation in which he treated a young female with a methamphetamine addiction. He stated that this issue should be funded as any other mental health issue is funded. Dr. Kessler provided a handout in support of the bill (Attachment B). He encouraged the committee to look at substance abuse as a disease and address it how diseases are treated, rather than address it with harsher punishment of jail time. He stated that prevention has shown to be effective in reducing drug abuse.

01:51 PM -- Scott Matthews, March of Dimes, testified in support of the bill. Ms. Matthews provided a handout in support of the bill to the committee (Attachment C). He provided details to the committee regarding children born with fetal alcohol syndrome and the resulting costs to the health care system. He stated that every birth can be healthy with prevention.

01:54 PM -- Chris Habgood, Division of Behavioral Health, Department of Human Services, testified in support of the bill. A white paper in support of the bill was provided to the committee (Attachment D). Committee members discussed what services are currently available under Medicaid and the difference between those services and the services the bill is offering to provide.

02:06 PM -- Joseph Stanley, Society of Addiction Counselors of Colorado, spoke in support of the bill. He described his clientele and the services they receive. He stated that if several of his clients had been identified with a substance abuse addiction earlier and received treatment the state could have saved several thousands of dollars. Members of the committee asked several questions of the witness regarding the benefits of the brief screening and intervention process. Mr. Stanley stated that while fifteen minutes with a physicians seems to be a short period of time, a lot can be accomplished.

02:15 PM -- Brie Reimann, Program Director, Peer Assistance Services, testified in support of the bill. Ms. Reimann provided a handout in support of the bill to the committee (Attachment E). She reiterated the data that Ms. Abbey provided to the committee regarding how much money is spent on prevention and treatment of substance abuse problems. Representative Roberts asked the witness if she could comment on the effectiveness of the program and how much in savings is actually realized. She stated that the private sector of physicians currently are reimbursed for the screening and brief intervention practice and noted that providers who accept Medicaid need to be reimbursed for the services they provide. Members discussed what services are reimbursed under Medicaid.

02:34 PM -- Dr. Broderick returned to the table to provide an example of what a screening might look like and to respond to committee questions about the model.

02:46 PM

Representative Massey provided concluding remarks to the bill. He stated that Colorado ranks third in substance abuse addiction. He stated the SBIRT is a proven and effective model.


BILL:	HB10-1033
TIME:	02:50:21 PM
MOVED:	Kerr J.
MOTION:	Moved to refer House Bill 10-1033 to the Committee on Appropriations. The motion passed on a 9-2 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	No
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	No

Final YES: 9 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:56 PM -- House Bill 10-1224

Representatives Gerou and Gagliardi presented House Bill 10-1224 which implements the recommendations of the Department of Regulatory Agencies in its sunset review of the Colorado Podiatry Board and continues the board until July 1, 2019.

03:01 PM -- Dr. Joseph Mechanik, Colorado Podiatry Association, testified in support of the bill. He described podiatrists' activities and the educational background required in order to practice podiatry.

03:05 PM -- Dr. Mathew Paden, practicing podiatrist, spoke in support of the bill, specifically section four which allows podiatrists to perform ankle surgery. Dr. Paden spoke to his experience in the field of podiatry. He provided background information regarding the last sunset review process.

03:08 PM -- Dr. Daniel MacFarlane, Colorado Podiatry Association, spoke in support of the bill. He stated that podiatrists may treat the bones of the ankle as well as tendons in the foot. He stated that the language in the bill clarifies and codifies current practice. He stated that the bill does not go beyond the scope of treatment which podiatrists currently use.

03:12 PM -- Jeff Jensen, Colorado Medical Podiatry Society, spoke in support of the bill. Dr. Jensen spoke to two letters in support of allowing podiatrists to treat soft tissue below the mid-calf (Attachments F and G).

03:16 PM -- Dr. Robert Sawyer, Colorado Medical Society (CMS), testified in support of the bill. He spoke to the provision in the bill allowing podiatrists to treat soft tissue and stated that CMS supports that provision.

03:22 PM -- Dr. Frederick Mechanik, podiatrist at Ft. Carson, spoke in support of the bill.

03:24 PM -- Dr. Gordon Rheaume, Colorado Coalition for Podiatric Reform, spoke in support of the bill.


BILL:	HB10-1224
TIME:	03:26:58 PM
MOVED:	Gagliardi
MOTION:	Move to adopt prepared amendment L.002 (Attachment H). The motion passed without objection.
SECONDED:	Kefalas
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Passed Without Objection


BILL:	HB10-1224
TIME:	03:27:51 PM
MOVED:	Gerou
MOTION:	Moved to adopt prepared amendment L.003 (Attachment I). The motion passed without objection.
SECONDED:	Roberts
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB10-1224
TIME:	03:29:15 PM
MOVED:	Gerou
MOTION:	Moved to adopt prepared amendment L.004 (Attachment J). The motion passed without objection.
SECONDED:	Roberts
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB10-1224
TIME:	03:30:52 PM
MOVED:	Gerou
MOTION:	Moved to refer House Bill 10-1224, as amended, to the Committee of the Whole. The motion passed on a 11-0 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

03:34 PM -- House Bill 10-1226

Representative Kefalas spoke to House Bill 10-1226 which adds statutory language to allow county child protection workers in five pilot counties to use an alternative response to cases that meet the legal definition of child abuse and neglect, but are determined to be low or moderate in severity. A handout in support of the bill was provided to the committee (Attachment K).

03:37 PM -- Lloyd Malone, Department of Human Services, spoke in the support of the bill. Mr. Malone explained what the term "differential response" means and described the different levels of treatment that may be applied to families that are involved with child abuse or neglect. He provided an example of what the department determines to be low or moderate in severity.

03:44 PM -- Dr. Skip Barber, Colorado Association of Family and Children Agencies, testified in support of the bill. Dr. Barber also stated he was part of the Governor's Child Welfare Action Committee. He explained the benefits of the bill for county departments of human services.

03:47 PM -- Angela Mead, Larimer County Department of Human Services, spoke in support of the bill. Ms. Mead explained that Larimer County is one of the counties that were selected to be apart of the pilot program. Ms. Mead explained the current procedure for investigating alleged abuse. She stated that the bill allows the county to use another tool in addressing suspected abuse. She spoke to other states that have implemented a differential response model. She stated that results of these programs have been successful.

03:57 PM -- Cheryl Ternes, Director, Arapahoe County of Human Services and President of the Colorado Social Services Directors Association, spoke in support of the bill.

03:58 PM -- Pat Ratliff, Colorado Counties Inc., spoke in support of the bill.

04:00 PM -- Carla Bennett, League of Women Voters, spoke in support of the bill.


BILL:	HB10-1226
TIME:	04:03:08 PM
MOVED:	Kefalas
MOTION:	Moved to adopt prepared amendment L.002 (Attachment L). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

04:05 PM

Representative Kefalas provided concluding remarks on the bill.


BILL:	HB10-1226
TIME:	04:08:28 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 10-1226, as amended, to the Committee of the Whole. The motion passed on a 11-0 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:10 PM

The committee took a brief recess.

04:21 PM -- House Bill 10-1283

The committee reconvened. Representative Riesberg introduced House Bill 10-1283. He distributed amendment L.001 (Attachment M). The bill requires that medical doctors engage in ongoing professional development and attest to that when obtaining or renewing a license from the Board of Medical Examiners in the Department of Regulatory Agencies (DORA). Doctors are required to keep documentation of professional development activities and failure to continue ongoing professional development is defined as unprofessional conduct. He stated that the bill also creates the Patient Safety Act which requires health care providers to make reasonable efforts to verify the employment history and references of all applicants for any job that involves access to patients. Representative Riesberg also stated the bill requires health care providers to share information regarding a health care applicant's work impairment, drug diversion, or patient abuse. Representative Riesberg noted that the bill is dually assigned to the Committee on Judiciary so that many of the committee's legal questions may be addressed there.

04:39 PM -- Lauren Lollini, concerned citizen, spoke in opposition to the bill. She stated that she was one of the first individuals linked to the outbreak of Hepatitis C at Rose Medical Center. She stated that she is extremely concerned with patient safety. She stated her concerns relate to the provisions that allow physicians to share information between facilities. She stated that she would like to see more information available in a more timely manner.

04:43 PM -- Natalie Brown, Colorado Trial Lawyers Association (CTLA), spoke in opposition to the bill. She stated that there are unintended consequences in the bill. She stated the bill changes what may be admissible in court regarding a physician's conduct. She also commented on the language in the bill regarding the "assessment of care." She stated that the definition in the bill would allow any encounter between a physician and a patient to be admissible in court. She stated that the bill is vague and broad. She stated that she understands the intent of the bill, but stressed that this bill is not going to increase patient safety. Committee members discussed how the bill could be made better. Ms. Brown stated that the bill is over broad and she is concerned with the unintended consequences.

05:10 PM -- Dr. Mark Laitos, Colorado Medical Society, spoke in support of the bill. Three issues of Colorado Medicine, a publication of the Colorado Medical Society, with articles highlighting patient safety were distributed to the committee (Attachments N, O, and P). Dr. Laitos stated that the first part of patient safety begins with physician licensure. He stated that there is not a good model to encourage physicians to speak with their peers concerning poor outcomes. He stated the the third section of the bill addresses this practice. He stated it is important for physicians to be able to learn from each other and understand each others best practices. He spoke to the language in the bill, specifically the "assessment of care" language that Ms. Brown referenced. He stated that it was not the intention of the bill to allow every conversation or written material between a physician and a patient to be open to the court.

05:29 PM

There was discussion regarding the interactions of the Colorado Medical Society and the Colorado Trial Lawyers Association's regarding the development of the bill. Kari Hershey, Colorado Medical Society, spoke to the interaction between the two organizations. Committee members discussed their concern regarding whether patient interaction with his or her physician may or may not be admissible in court. Discussion ensued regarding the "I'm Sorry" law which allows physicians to apologize to patients without their statements being construed as admissions of negligence in medical malpractice lawsuits.

05:51 PM -- Janet Stephens, Colorado Hospital Association (CHA), spoke in support of the section in the bill which requires verification of a health care workers' employment. She stated that CHA supports patient safety measures. She stated that hospitals currently are not able to share information regarding health care workers. She stated that the bill would allow a hospital to share specific information to ensure patient safety. Committee members discussed privacy issues regarding the bill.

06:05 PM -- John Francis, Colorado Hospital Association, spoke in support of the bill. He stated that he is a private hospital peer review attorney. He commented that the bill expands disclosure of discoverable information in a court.

06:07 PM

Representative Roberts commented on Mr. Francis' testimony, and asked him to explain the peer review process. He explained that it is an internal review of patient safety conduct of doctors. He stated that hospitals would be able to share information with one another if this bill passes. He stated that learning from another physician's mistake will only make the practice of medicine better.

06:14 PM -- Patty Skolnik, Citizens for Patient Safety and the mother of Michael Skolnik, spoke in support of the bill. Ms. Skolnik described her son's surgery and subsequent death. She provided a handout regarding her son to the committee (Attachment Q). She commented on the culture surrounding disclosure for physicians. She stated that this bill is one step towards making Colorado safer for patients.

06:20 PM -- Rose McCool, Director, Division of Registrations, Department of Regulatory Agencies, spoke to the section concerning continuing professional development. She stated that the division is neutral to the bill and are working towards supporting it.

06:23 PM -- Edie Sonn, Colorado Medical Society, spoke about Ms. Brown's comment related to making interactions between physicians and patients open for discovery. She spoke to the development of the bill between the CTLA and the Colorado Medical Society.


BILL:	HB10-1283
TIME:	06:27:38 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.001 (Attachment M). Representative Riesberg described the amendment. The motion passed without objection.
SECONDED:	Roberts
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

06:31 PM

Representative Riesberg provided concluding remarks on the bill.


BILL:	HB10-1283
TIME:	06:33:39 PM
MOVED:	Riesberg
MOTION:	Moved to refer House Bill 10-1283, as amended, to the Committee on Judiciary. The motion passed on a 8-3 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	No
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

06:35 PM -- House Bill 10-1216

Representative Riesberg presented House Bill 10-1216 which allows a licensed pharmacist to take immunizations and vaccines off the premises of a pharmacy to administer the drugs. He stated that he realized this bill could be effective given the recent scare of the H1N1 outbreak. He spoke to amendment L.002 which removes chiropractors from the bill (Attachment R).

06:39 PM -- Shannon Butler, Colorado Retail Council, spoke in support of the bill.

06:41 PM -- Joel Giles, representing Pharmaceutical Research and Manufacturers of America (PhRMA), spoke in support of the bill. Mr. Giles stated that he is also the clinical coordinator for King Soopers pharmacies. He stated that the bill does not necessarily change pharmacists' practice, however the bill allows pharmacists to work with various community partners to provide immunizations effectively on-site and off-site.

06:46 PM -- Brian Pahr, Clinical Coordinator of Safeway, testified in support of the bill. He concurred with Mr. Giles' testimony regarding the demand for the H1N1 immunization over the past season. He stated that many groups, such as individuals living in assisted living facilities or nursing homes, requested the immunization. He stated that the pharmacies had the immunization in stock but were prohibited from providing the vaccine at those places.

06:50 PM -- Marla Frawner, Director of Pharmacy, King Soopers, testified in support of the bill. She stated she has been an immunizer since 2002 and a pharmacist for over 20 years.

06:54 PM -- Brad Young, Government Director, Rx Plus Pharmacies, spoke in support of the bill. He stated that Val Kalnins of the Colorado Pharmacists Association and Susan Cox of Kaiser Permanente also support the bill.


BILL:	HB10-1216
TIME:	06:57:38 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.002 (Attachment R). The amendment removes chiropractors from the bill. The motion passed without objection.
SECONDED:	Kefalas
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB10-1216
TIME:	06:59:00 PM
MOVED:	Riesberg
MOTION:	Moved to refer House Bill 10-1216, as amended, to the Committee of the Whole. The motion passed on a 11-0 roll call vote.
SECONDED:	Acree
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:00 PM

The committee adjourned.