Public Health Committee

MEETING MINUTES

Monday, March 30, 2015

10:30 AM in Room 1D of the LOB

The meeting was called to order at 10:30 AM by Chairman, Rep. Ritter M. 001.

The following committee members were present:

Senators:

Crisco J. S17; Gerratana T. S06; Kane R. S32; Kennedy T. S12; Markley J. S16; Moore M. S22

   

Representatives:

Alexander D. 058; Baker A. 124; Berthel E. 068; Candelora V. 086; Carpino C. 032; Conroy T. 105; Cook M. 065; Demicco M. 021; Genga H. 010; McCarty K. 038; Perillo J. 113; Riley E. 046; Ritter M. 001; Ryan K. 139; Scanlon S. 098; Srinivasan P. 031; Tercyak P. 026; Wilms F. 142; Zoni D. 081

   

Absent were:

 
   

Senators:

   

Representatives:

Adinolfi A. 103; Betts W. 078; Sayers P. 060

Representative Ritter convened the meeting and announced that the committee will be in recess until 11:00 AM.

Senator Gerratana reconvened the meeting at 11:00 AM and announced votes will be held open until 6:00 PM.

Senator Gerratana asked for a motion to JFS to the Floor H.B. No. 7006 (RAISED) An Act Concerning Birth Certificate Amendments.

A motion was made by Representative Ritter and seconded by Representative Riley.

Representative Ritter explained that current law prohibits sex designation to be changed on birth certificates unless the individual undergoes a gender reassignment surgery. This bill will allow a sex designation to be changed on birth certificates with a notarized affidavit from a licensed physician, APRN, or psychologist stating that the person has undergone surgical, hormonal, or other appropriate treatment.

Representative Perillo asked if this legislation provides any advantages given to an individual.

Representative Ritter referred to testimony submitted to the committee which addressed the awkwardness for individuals who apply for employment whereas birth certificates are required for the application process.

Representative Srinivasan asked for clarification of other clinically approved treatments as written in the bill.

Representative Ritter acknowledged that there have been questions on this term from both sides of the aisle and a definition may be beneficial as the bill moves forward in the House.

Representative Srinivasan asked if this bill restricts a person who changes their gender and then decides to change back.

Representative Ritter pointed to line 40 in the bill which identifies the required written statement that an applicant's gender differs from the sex designated on the original birth certificate.

Representative Zoni asked if there are age restrictions for gender change.

Representative Ritter explained that there are no major restrictions under Title VII.

A Roll Call vote was taken: Total Voting – 25, Yea – 23, Nay – 2, Absent and Not Voting – 3. The motion passed.

Representative Ritter asked for a motion to JFS to the Floor S.B. No. 467 (COMM) An Act Concerning the Facilitation of Telehealth.

A motion was made by Representative Riley and seconded by Senator Gerratana.

Senator Gerratana explained that this bill sets the framework for telehealth and explained limitations such as physical examinations and diagnostic testing, insurance company provisions, and the exclusion of certain prescriptions.

Representative Srinivasan asked if there is a requirement for the first visit to be held in person.

Senator Gerratana explained that there is no such requirement in this legislation. In addition, this requirement would defeat the purpose of using telehealth as a healthcare ancillary modality.

Representative Srinivasan expressed belief that individuals will use telehealth for issues that are not life-threatening and there should be a relationship established for providers and their patients prior to telehealth interaction.

Senator Gerratana stated that there is no language in the bill that will prevent a provider from an initial face-to-face visit.

Representative Srinivasan asked if telehealth will be included, from an insurance perspective, in Medicaid and Medicare.

Senator Gerratana explained that there is currently telemedicine statue regarding Medicaid services; however, she is uncertain as to how this would relate to Medicare.

Representative Srinivasan asked for clarification and confirmation that insurers are able to decide if certain services are not conducive to telehealth, and if insurers are able to opt out the particular service.

Senator Gerratana explained that insurers will have the ability to make a determination for telehealth services they will not insure.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JFS H.B. No. 6285 (COMM) An Act Concerning Smoking in Motor Vehicles.

A motion was made by Representative Genga and seconded by Representative Riley.

Representative Ritter explained this bill will prohibit smoking in a car that carries a child restraint system. The first offense shall be a written warning, subsequent to this there will be an infraction. In addition, smoking in a car in violation of this bill will not constitute probable cause for a search of the vehicle.

Representative Genga stated this bill is endorsed by the Chief of Police Association. Police officers would not be looking for this offense; however, they will issue violations if they see offense. In addition, a study was conducted by Harvard University that concluded a small child will consume multiple times above the safe levels of smoke as defined by the EPA, in a car with windows open a couple inches, and identified seven states with similar legislation.

Representative McCarty asked for clarification of the penalty portion of the legislation, and questioned the involvement of other agencies if the child is determined to be at risk.

Representative Genga stated the first offense will be a warning and that a survey reported a 44% reduction of drivers smoking after the first written warning in Maine.

Representative Ritter added the second offense would be an infraction. In addition, the legislative body would have to include language in criminal statute to state if smoking in a motor vehicle was to be considered as a risk to a minor.

Representative Srinivasan stated this is a great bill and a good first step; however, the legislature will eventually need to move forward to prevent secondhand smoking to all children.

A Roll Call vote was taken: Total Voting – 25, Yea – 21, Nay – 4, Absent and Not Voting – 3. The motion passed.

Representative Ritter announced that Representative Betts was out of town for constituent services and Representative Adinolfi is absent for medical reasons.

Representative Ritter asked for a motion to JF to the Floor S.B. No. 800 (COMM) An Act Concerning a Pilot Program Allowing Emergency Medical Services Personnel to Provide Community-Based Health Care Services.

A motion was made by Senator Gerratana and seconded by Representative Riley.

Senator Gerratana stated this bill requires the Department of Public Health to establish three pilot programs in different municipalities, allowing emergency services personnel to provide community-based health care services. The community-based health care service must include transporting individuals to places other than hospitals emergency departments when appropriate, providing home visits for certain purposes, and providing primary care services to the medically underserved populations. In addition, Senator Gerratana explained that additional work will be done as the bill moves through the process.

Representative Srinivasan believed that the bill is a great concept; however, he expressed a concern regarding the primary care component of the legislation.

Senator Gerratana agreed, and stated the primary care component will be taken out of the bill.

A Roll Call vote was taken: Total Voting – 25, Yea – 24, Nay – 1, Absent and Not Voting – 3. The motion passed.

Representative Ritter asked for a motion to JF to the Floor S.B. No. 812 (COMM) An Act Concerning Electronic Health Records and Health Information Exchange.

A motion was made by Senator Gerratana and seconded by Representative Riley.

Senator Gerratana acknowledged a need for the State of Connecticut to coordinate electronic records; this bill would establish a state wide information exchange to allow real time information access.

Representative Srinivasan explained his involvement with the task force and roundtable discussions, and pointed to a model in which Rhode Island already has in existence. Although this legislation is very ambitious, it is something that is needed in Connecticut.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Representative Ritter asked for a motion to JF to the Floor S.B. No. 813 (COMM) An Act Concerning Health Care Price, Cost and Quality Transparency.

A motion was made by Senator Gerratana and seconded by Representative Riley.

Senator Gerratana explained this legislation contains various provisions regarding health care costs and quality information available to consumers. This bill will allow people to look at commonly performed procedures and utilization of medical services.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Representative Ritter asked for a motion to JF to the Floor S.B. No. 814 (COMM) An Act Concerning State Accountable Care Organizations.

A motion was made by Senator Gerratana and seconded by Representative Riley.

Senator Gerratana stated the bill would require the Department of Public Health to establish a voluntary certification process for accountable care organizations.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Representative Ritter asked for a motion to JF to the Floor S.B. No. 815 (COMM) An Act Establishing a Commission on Health Care Policy, Cost Containment and Price Variation.

A motion was made by Senator Gerratana and seconded by Representative Riley.

Senator Gerratana explained this bill establishes an independent commission and sets up a parameter for who will be on the commission.

Representative Perillo expressed opposition to the bill citing the language of the bill is too vague and that the bill would bring additional costs to providers.

A Roll Call vote was taken: Total Voting – 25, Yea – 20, Nay – 5, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JFS H.B. No. 5101 (COMM) An Act Concerning License Requirements for Certain Types of Pools.

A motion was made by Representative Ritter and seconded by Representative Riley.

Representative Ritter explained this bill will create a sliding scale for fees, as well as, classification for pools. In addition, the section of legislation allowing the Department to adopt regulations without going through the review process had been removed at the request of some members of the committee.

Representative McCarty stated she could not locate the reduction in the fee for different types of pools in the bill.

Representative Ritter explained that the concern brought to the committee was on the flotation vessel device. There are fees; however, the issue brought to the committee had been addressed through the exclusion of flotation vessels.

Representative McCarty asked if the exclusion of flotation vessels would satisfy the reduction in the fee.

Representative Ritter explained that there would be no fee because flotation vessels are excluded from the definition.

Representative Srinivasan clarified that the sub-classification of swimming pools into various categories have the same fee regardless of the type of pool.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passes.

Senator Gerratana asked for a motion to JFS to the Floor H.B. No. 6283 (COMM) An Act Regulating Electronic Nicotine Delivery Systems and Vapor Products.

A motion was made by Representative Ritter and seconded by Representative Riley.

Representative Ritter commented on opposing testimonies shared with committee and express beliefs that the committee created a fair compromise. The bill will ban the use of electronic cigarettes, vapor products, and similar devices in places where cigarettes are prohibited. In addition, the bill will require these devices to be child-resistant and incorporates language that will require the Public Health committee to hold a public hearing to review all rules and laws relating to electronic vapor products thirty days after the release of the FDA report on such devices.

Representative Srinivasan explained his difficulties with this legislation. He explained that as a doctor and strong advocate against smoking, he cannot recommend smoking; however there is an understanding of the possibilities electronic vaping products can have to combat the addition. In addition, Representative Srinivasan expressed his concerns that restricting the use of these products may encourage individuals to return to cigarettes.

Representative Ritter shared his concern for a scenario in which the FDA releases a negative report and the legislature had not taken minor steps to address the potential problem. He would prefer the legislature take steps to amend statute should the FDA release a positive report on the electronic devices. From a public health perspective, it would be better to regulate on the front end, with the current information available, rather than regulate on the backend. In addition, the single greatest restriction that is placed are on restaurants and bars. Although some individuals may be inconvenienced by the bill, prohibiting vaping in certain locations is a reasonable accommodation to what this bill seeks to address.

Representative Perillo expressed understanding for Representative Ritter's argument, but disagreed he would disagree in the order in which the legislature is approaching the bills intent. There are no definitive answers to the health effects of electronic vaping products. In addition, Representative Perillo is concerned with the precedent the Public Health Committee is setting by regulating certain things before there is definite information on the health effects of certain products.

Representative Srinivasan reminded members of the mixed feelings he had previously shared and announced that Representative Ritter's argument had compelled him to support this bill out of committee.

Representative Cook expressed concerns with ingredients that individuals use in the electronic vaping devices such as liquid hemp as they relate to children. It is the job of the legislature to protect children.

Senator Kane stated that the legislature had previously banned the sale of electronic cigarettes to children.

Senator Kane expressed bout that the legislation has anything to do with children and agrees with Representative Perillo's comment in that the legislature is trying to act before any regulations have been released by the FDA. He added the legislature should not set policy based on opinion.

Representative Ritter explained that the body of evidence he had reviewed seemed to indicate the harmful effects of these products and does not believe the legislature is taking measures too soon.

Representative Candelora shared an experience he had with a Boy Scout trip at a facility in which smoking was clearly banned. He was caught off-guard when parents had taken out their electronic vaping product and was not sure how to address this as it was not technically a banned product. Limiting the places where people can smoke this product is an inconvenience, but as a public policy, the legislature should want to keep children away from these products as much as possible.

Representative Ritter added that language is written to allow the legislature to act on what is enumerated in statute and if an issue is not addressed, the legislature will defer to the municipality.

Representative Wilms expressed his support for this bill and added his concern, other than the ingredients used, is the perception and message that is being sent. Electronic vaping products send the wrong public health message.

Representative McCarty asked what the process was for amending the legislation after regulations are established by the FDA.

Representative Ritter explained that the law would be amended in the following session.

Representative Scanlon commented that although electronic cigarettes are banned for children, it does not mean that children will not use these products. In addition, addict smokers are going to continue to smoke and the idea that smokers will be deterred from vaping is irrelevant because smokers already have to smoke outside if they wish to smoke.

In response to Representative Scanlon's statement, Senator Kane asked why the legislature does not ban drinking alcohol in front of children. The legislature is traveling down a dangerous road with policy based on personal opinion.

Representative Ritter stated supporters of this legislation have addressed the negative impact this product can have on individuals in the immediate area surrounding the user, unlike alcohol.

A Roll Call vote was taken: Total Voting – 25, Yea – 21, Nay – 4, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JF to the Floor H.B. No. 6284 (COMM) An Act Concerning the Advertising of Services by Health Care Providers.

A motion was made by Representative Ritter and seconded by Representative Cook.

Representative Ritter explained this bill requires health care provider advertisements to identify the type of license and other credentials, and be free from deceptive or misleading information. In addition, health care provider advertisements, upon request, must provide a list of providers and their credentials.

Representative Srinivasan stated the intent of the legislation is to allow patients to know, without any ambiguity, the professional providing the patient services. Many times patients assume the individual assisting the patient is a medical doctor.

Representative Cook supports a patient's ability to know what health care practitioner is providing them with treatment and asked if there are financial repercussions to providers not in compliance with this bill.

Representative Srinivasan explained that there should be a price, if this legislation is enacted into law, health care providers not in compliance with the law should be paying.

Representative Cook asked if individuals not wearing identification will be charged directly.

Representative Srinivasan explained that the person responsible is the health care facility. It would be up to the employer to enact policy to address problems regarding their employee.

Representative Cook asked if there is a definitive answer to a financial charge the legislature would impose. In addition, if the facility is charged, would the legislature allow employers to determine if they will charge the fine to their employee?

Representative Srinivasan answered in the affirmative.

Representative Conroy asked who would be enforcing the policy.

Representative Srinivasan explained that the noncompliance would be brought as a complaint of the provider and facility to the Department of Public Health.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JF to the Floor H.B. No. 6490 (COMM) An Act Establishing a Pilot Program for Persons Diagnosed with Autism Spectrum Disorder.

The motion was made by Representative Cook and seconded by Representative Ritter.

Representative Ritter explained the bill would require the commissioner of the Department of Developmental Services to establish a pilot program for twenty-four people with developmental disability or autism spectrum disorder.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JFS to the Floor H.B. No. 6814 (RAISED) An Act Concerning Dental Assistants and Expanded Function Dental Auxiliary.

A motion was made by Representative Ritter and seconded by Representative Zoni.

Representative Ritter explained this legislation will add a new category for dental care to statute which is termed Expanded Function Dental Auxiliary. Dental auxiliaries will be allowed to perform certain procedures, under the direct or indirect supervision of a dentist, which are currently not allowed.

A Roll Call vote was taken: Total Voting – 25, Yea – 24, Nay – 1, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JF to the Floor H.B. No. 6862 (RAISED) An Act Concerning a Study of the Palliative Use of Marijuana for Children.

A motion was made by Representative Ritter and seconded by Representative Riley.

Senator Gerratana explained this legislation will require the commissioner of the Department of Public Health, in consultation with the commissioner of Consumer Protection, to study the palliative use of marijuana for children and to submit a report to the General Law and Public Health Committees.

Representative Srinivasan shared his strong support for this legislation and cited testimony of children who are successfully treated out of state.

Senator Kane commented on the committee's position on not wanting children to vape, but would allow children to use marijuana. He added that the committee just had a discussion surrounding the dangers of vaping on children, yet there will be a study to see if children can use marijuana.

Representative Candelora stated he would not support moving the bill out of committee. There is similar legislation in the Judiciary Committee which approaches this issue in a research and clinical route, rather than a study. Research and clinical trials are a better approach.

Representative McCarty stated she would vote in favor of this legislation based on testimony that had been shared with the committee and asked if there are possibilities for the clinical trials and study to work together.

Senator Gerratana stated the Judiciary Committee had not yet taken action on the similar legislation. The research and clinical study would, most likely, be included if both legislation were to move forward. However, both legislation are concept ideas.

Representative Perillo pointed out the title of the bill as the palliative use of marijuana, and added that testimony shared with the committee addressed the therapeutic use. It should not be the role of the Department of Public Health to determine what therapeutic use is, the determination should be left to the United States Food and Drug Administration.

A Roll Call vote was taken: Total Voting – 25, Yea – 19, Nay – 6, Absent and Not Voting – 3. The motion passed.

Senator Gerratana asked for a motion to JFS to the Floor H.B. No. 6987 (RAISED) An Act Concerning Various Revisions to the Public Health Statutes.

A motion was made by Representative Riley and seconded by Representative Cook.

Senator Gerratana explained that this bill addresses technical revisions to current public health statutes and added that LCO #5969 is the substitute language for discussion.

A Roll Call vote was taken: Total Voting – 25, Yea – 25, Nay – 0, Absent and Not Voting – 3. The motion passed.

Senator Gerratana announced that Representative Sayers did not attend the meeting due to medical reasons. In addition, Senator Gerratana, on behalf of both chairs, thanked the committee's Legislative Attorneys, Legislative Researchers, and committee staff members.

The meeting was adjourned at 6:00 PM.

Beverley Henry

Ussawin Robin Bumpen

Administrator

Committee Clerk