House Committee on Health and Human Services (03/19/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/19/2009	ATTENDANCE

Time:	01:32 PM to 07:23 PM	Acree	*
		Fischer	X
Place:	LSB A	Gerou	X
		Green	X
This Meeting was called to order by		Kefalas	X
	Representative Riesberg	Kerr J.	X
		Nikkel	X
This Report was prepared by		Primavera	X
	Kelly Stapleton	Swalm	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB09-1028 SB09-012 HB09-1306		Amended, Referred to Appropriations Postponed Indefinitely Postponed Indefinitely

01:33 PM -- House Bill 09-1028

Representative Frangas spoke to House Bill 09-1028 which, as amended, would require the Department of Health Care Policy and Financing to establish procedures to resolve grievances from medically indigent persons who are enrolled in the Colorado Indigent Care Program (CICP). House Bill 09-1028 was heard in the House Health and Human Services Committee February 2, 2009, and was referred to the Committee of the Whole. The Committee of the Whole referred the bill to the House Finance committee which heard the bill on March 10, 2009, and then re-referred the bill back to the House Health and Human Services Committee.

01:43 PM

Committee members asked several questions of the sponsor. There were questions regarding the fiscal note and if it reflected the amended bill. Representative Frangas spoke to amendments L.005, which is a strike below amendment, and L.006, which amends the strike below amendment (Attachments A and B). Representative Riesberg asked the committee whether it wanted to hear testimony on the bill. There was discussion regarding procedures concerning re-referred bills.

01:58 PM

Julie Reiskin, Colorado Cross Disability Coalition, spoke in support of the strike below amendment, amendment L.005 (Attachment A). She explained to the committee why the bill was referred to the House Committee on Finance from the Committee of the Whole, and then why it was re-referred back to the House Health and Human Services Committee. She spoke to a memorandum regarding the fiscal note dated March 19, 2009 (Attachment C). She stated that she would prefer that the bill establish a citizen oversight board, but she stated that it is unrealistic given the cost of the fiscal note. She provided a letter from a constituent of Representative Kefalas regarding the impacts of a lack of grievance process (Attachment D).

02:06 PM -- Janet Stephens, Colorado Hospital Association, spoke in support of the strike below amendment. She spoke to the grievance process hospitals must follow when a patient is unsatisfied with their care. Committee members asked if Ms. Stephens was familiar with how the grievance process occurs through the department. She stated she was not familiar with the process.

02:19 PM -- Jennifer Miles, Colorado Community Health Network (CCHN), stated that the health network supports some kind of grievance process for CICP clients. She reiterated that CCHN does not support the bill without the adoption of the strike below amendment. She stated that the Joint Budget Committee cut the Comprehensive Primary and Preventative Care Grant Program from $3 million down to $300,000, so the proposed funding for the bill has all but been removed. She stated that CCHN has some concerns with exempting out one type of provider as amendment L.006 does. She stated that all patients who have a complaint go through a similar process, regardless of their status, or if the client is enrolled in the CICP.

02:29 PM -- Chris Underwood, Director, Division of State Programs and Federal Funding, Department of Health Care Policy and Financing, provided a handout to the committee regarding the grievance process for CICP clients which is currently in place (Attachment E). Mr. Underwood explained the process and stated that CICP clients are encouraged to call the department's customer services number. He stated that on the backside of the handout, the department, in collaboration with the CICP Stakeholders Forum, provides further suggestions on how to address the grievance process for CICP clients. He acknowledged that the process needs to be reviewed and marketed better, but he stated the department does not support putting something into law.

02:45 PM

Representative Frangas stated that there is a need to put this process in state law to provide legislative intent. He questioned what might happen if the current executive director leaves the department. He stated that the new executive director may not have the same intention as the current executive director has.


BILL:	HB09-1028
TIME:	02:50:58 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.005, which is a strike below amendment (Attachment A). The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Fischer
	Gerou
	Green
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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

02:50 PM -- Representative Primavera stated that she would like to consider amendment L.006 without the hospital exemption. Committee members discussed severing amendment L.006. Section A of amendment L.006 consists of lines 1 though 5. Section B of amendment L.006 consists of lines 6 though 10.


BILL:	HB09-1028
TIME:	02:51:46 PM
MOVED:	Riesberg
MOTION:	Moved to adopt severed amendment L.006, Section A (Attachment B). The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Fischer
	Gerou
	Green
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1028
TIME:	02:52:35 PM
MOVED:	Riesberg
MOTION:	Moved to adopted severed amendment L.006, Section B. The motion failed on a 5-6 roll call vote.
SECONDED:	Green
		VOTE
	Acree	Yes
	Fischer	No
	Gerou	Yes
	Green	No
	Kefalas	No
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	No
	Riesberg	No

Not Final YES: 5 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1028
TIME:	02:54:49 PM
MOVED:	Green
MOTION:	Moved to refer House Bill 09-1028, as amended, to the Committee on Appropriations. The motion passed on a 6-5 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Fischer	Yes
	Gerou	No
	Green	Yes
	Kefalas	Yes
	Kerr J.	No
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:57 PM -- Senate Bill 09-012

Representative Frangas presented Senate Bill 09-012. He spoke to a strike below amendment, amendment L.006, which will require the interim Health Care Task Force to study professional review committees, and to review and investigate the quality and appropriateness of patient care provided by health care providers working for prehospital services agencies (Attachment F). There was discussion regarding whether a statutory change was needed to require the Health Care Task Force to study the issue, given that the bill was referred from the interim Health Care Task Force from 2008.

03:27 PM -- Howard Paul, Executive Director, Emergency Medical Services Association of Colorado, spoke in support of the bill.

03:31 PM -- Janet Stephens, Colorado Hospital Association, spoke in support of the bill with the adoption of amendment L.008, which changes the title of the bill to address prehospital services and removes trauma centers from the title (Attachment G).


BILL:	SB09-012
TIME:	03:37:34 PM
MOVED:	Green
MOTION:	Moved to adopt prepared amendment L.006 (Attachment F). The motion failed on a 4-7 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Fischer	Yes
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	Yes

Not Final YES: 4 NO: 7 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-012
TIME:	03:38:22 PM
MOVED:	Fischer
MOTION:	Moved to adopt prepared amendment L.008 (Attachment G). The motion failed on a 3-8 roll call vote.
SECONDED:	Primavera
		VOTE
	Acree	No
	Fischer	Yes
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	No

Not Final YES: 3 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-012
TIME:	03:41:09 PM
MOVED:	Green
MOTION:	Moved to refer Senate Bill 09-012 to the Committee of the Whole. The motion failed on a 2-9 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	No
	Fischer	No
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	No

Not Final YES: 2 NO: 9 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-012
TIME:	03:43:20 PM
MOVED:	Kerr J.
MOTION:	Moved to postpone Senate Bill 09-012 indefinitely. The motion passed on a 9-2 roll call vote.
SECONDED:	Swalm
		VOTE
	Acree	Yes
	Fischer	Yes
	Gerou	Yes
	Green	No
	Kefalas	Yes
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

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

03:44 PM -- The committee took a brief recess.

03:53 PM -- House Bill 09-1306

The committee reconvened. Representative Nikkel presented House Bill 09-1306, which sets forth procedures for reporting incidents of abuse or neglect at juvenile detention facilities operated by the Department of Human Services (DHS). The bill requires the DHS to establish a telephone hotline for juveniles and their families to call to report injuries or abuse. Representative Nikkel discussed her concern with the fiscal note. She spoke to amendments L.001 and L.002 (Attachments H and I respectively). She stated that amendment L.001 will reduce the fiscal note. Representative Nikkel provided a packet of information to the committee including:

a letter from Brian Brandon asking Representative Nikkel to change the policies at juvenile detention centers (Attachment J);

a chart regarding child abuse reports and founded allegations from 2004 to 2009 (Attachment K);

a report from the Platte Valley Youth Services Center on the number of critical incidents reports filed by the youth center (Attachment L);

a newspaper article from the Boulder Daily Camera regarding the alleged abused at the Platte Valley Youth Center (Attachment M); and

a map of the locations of the Division of Youth Corrections detention centers in Colorado (Attachment N).

04:06 PM -- John Gomez, Division of Youth Corrections, Colorado Department of Human Services, testified in opposition to the bill. Mr. Gomez referred to a chart which provides a side by side comparison between requirements that are currently in statute or in rule versus requirements under the bill (Attachment O). He stated that many of provisions that are in the bill are already in statute. He stated that when staff become hesitant to intervene when a violent situation occurs, it can then become a serious situation. He stated that the bill poses too many unintended consequences. He emphasized that the facilities in question are not child care facilities, but juvenile detention centers. He stated that children in youth detention centers are ordered by the court to detention, which indicates that they are a danger to their environment.

04:30 PM

Mr. Gomez stated the Division of Youth Corrections staff have been authorized by the General Assembly to use reasonable force. He stated that if that authority is eroded, the youth could be put in more dangerous situations. He also stated that the Division of Youth staff do not carry weapons. A statement from the DHS in opposition to the bill was provided to the committee (Attachment P). Mr. Gomez acknowledged that the DHS is performing a systemic review of the child welfare system. He stated that the committee should wait for the recommendations of that review before implementing a significant change in law. Mr. Gomez responded to committee questions.

04:45 PM

Mr. Gomez explained to the committee the procedures in place when dealing with a potentially violent youth in a detention center. He explained that the youths are permitted to submit grievances to a number of people. Mr. Gomez responded to Representative Kefalas's question regarding how the division deals with a situation when a child does not feel safe to speak. He stated that the division has trained staff that know what to look for and that the staff is also provided on-going training.

05:10 PM -- Dr. Skip Barber, Director, Colorado Association of Family and Children Agencies, spoke in opposition to the bill. He stated that the youths in the detention centers frequently file reports alleging abuse. He stated that law enforcement keeps detailed records of these reports. He stated that the bill states that 'any injury incurred must be reported.' He stated that provision will cause a serious impact on the number of staff required to treat these children. He stated that the Child Welfare Action Committee is about a month away from making recommendations to the General Assembly and Governor regarding the child welfare system. He stated one of the potential recommendations is to create an office that would deal with appeals of alleged abuse complaints. He stated that after working in the state system for over 30 years, the system works and does self-report regarding alleged abuse. He reiterated that the bill duplicates many provisions already in statute.

05:20 PM -- Anders Jacobson, Director, Lookout Mountain Youth Services, Division of Youth Corrections, Department of Human Services, spoke in opposition to the bill. Mr. Jacobson stated that safety of the youth is the upmost importance to him as the director of a youth detention facility. He stated that the provisions in the bill will decrease the working relationship between the staff at the detention facility and the police department. He stated it would undermine the processes in place to deal with reporting of alleged abuse. He stated that in fifteen years in which he has worked in the system, it has worked effectively. He concurred with Mr. Gomez's testimony regarding the training of the staff in dealing with juvenile offenders. He stated that the bill would create an "us" versus "them" mentality and would not add to the therapeutic environment of the facility.

05:36 PM -- Ann Freeman, Regional Director of the Southern Region of the Colorado Youth Detention Centers, Division of Youth Corrections, Department of Human Services, testified in opposition to the bill. She described the population that is detained in the youth correction system. She stated that the bill does not add to the environment which has been established and would be a detriment to the gains made in the youth corrections facility. She stated that the installation of the hotline as proposed in the bill could be a significant danger to staff. She also said that if a child in a facility knows that if they make a report, the police will be called in, the police come in and take control of the situation. Ms. Freeman stated this will completely undermine the staff and their authority in these facilities. She also commented that the children in these facilities often do not want to change or to learn how to make different decisions.

05:56 PM -- Daryl Hollingsworth, Captain, Golden Police Department, Colorado Association of Chiefs of Police (CACP), and Guy Garner, police detective, Golden Police Department, spoke in opposition to the bill. Captain Hollingsworth stated that the bill is too broad as it is written. Captain Hollingsworth stated that police Detective Garner spends approximately 25 percent of his time addressing issues at the Lookout Mountain Youth Services detention center in Golden. He stated that if the bill passes, police Detective Garner would most likely spend all of his time at the facility, plus another detective would most likely be needed. Police Detective Garner stated that the police department is stretched to the limit at this time and asked the committee to take that into consideration.

06:13 PM -- George Kennedy, Deputy Executive Director, Office of Children, Youth, and Families, Department of Human Services, spoke in opposition to the bill. He acknowledged the spirit of the bill, but stated that he does not believe that the bill will accomplish increasing the protection of the youth currently detained in these facilities. Representative Kefalas encouraged Mr. Kennedy to open the process up to more transparency. Mr. Kennedy stated that he is open to discussion and welcomes any suggestions. He also reiterated that the Child Welfare Action Committee will be making recommendations to the General Assembly regarding the entire child welfare system, which includes the Division of Youth Corrections. Mr. Kennedy responded to committee questions.

06:34 PM -- John Malloy, representing himself, spoke in support of the bill. Mr. Malloy stated that he is a former correctional officer supervisor at the Platte Valley Youth Services Center. He provided a statement to the committee regarding his experience at Platte Valley Youth Services Center (Attachment Q). He stated that he believes the bill will improve the process of investigating and ensuring that residents have the opportunity to make allegations of abuse without interference from the staff members that may be abusing them. Committee members asked several questions of Mr. Malloy regarding his experience at Platte Valley Youth Services Center.

06:55 PM

Representative Nikkel gave concluding remarks regarding the bill. She addressed comments related to the hotline and reiterated the bill's provisions concerning the hotline. She stated that the division appears to be scared of the potential of change, but encouraged the committee to read the intent of the bill. She stated that there has been a culture and pattern of abuse and that it is the General Assembly's responsibility to end it.


BILL:	HB09-1306
TIME:	07:02:44 PM
MOVED:	Nikkel
MOTION:	Moved to adopt prepared amendment L.001 (Attachment H). Representative Nikkel stated that the amendment removes references to "injury" and replaces them with "child abuse and neglect". The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Fischer
	Gerou
	Green
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1306
TIME:	07:03:54 PM
MOVED:	Nikkel
MOTION:	Moved to adopt prepared amendment L.002 (Attachment I). Representative Nikkel explained the amendment. The motion passed without objection.
SECONDED:	Acree
		VOTE
	Acree
	Fischer
	Gerou
	Green
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1306
TIME:	07:05:52 PM
MOVED:	Nikkel
MOTION:	Moved to refer House Bill 09-1306, as amended, to the Committee on Appropriations. The motion failed on a vote of 3-8.
SECONDED:	Kerr J.
		VOTE
	Acree	No
	Fischer	No
	Gerou	No
	Green	No
	Kefalas	Yes
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	No
	Swalm	No
	Gagliardi	No
	Riesberg	No

Not Final YES: 3 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1306
TIME:	07:21:07 PM
MOVED:	Fischer
MOTION:	Moved to postpone House Bill 09-1306 indefinitely. The motion passed on a 6-5 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Fischer	Yes
	Gerou	Yes
	Green	No
	Kefalas	Yes
	Kerr J.	No
	Nikkel	No
	Primavera	No
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:22 PM

The committee adjourned.