SmartTranscript of HCI-2025-04-23-9:30 AM

[Chair Alice Emmons]: Okay. Welcome, folks. This is Ask Gretchen to Institutions. It's, days today. Thursday? Wednesday. Wednesday, April twenty third. Something Wednesday. We are having some committee discussion this morning on h three forty nine, which would create a state building security board to take over the security within our state buildings as well as the port houses to take that responsibility for our state buildings away from the Department of Buildings and General Services and for the courthouses to take that away from the Supreme Court. We've heard testimony from BGS in terms of what they provide for security. And then yesterday, we heard testimony from the state employees, BSEA, in terms of what's important for them for security and really recommending support of this bill. And there's opposing views from the sides. We heard from BGS. We heard from the courts. The courts are really concerned that by the constitution, the Supreme Court has oversight of the operations of the courts and the security by taking that away and giving it to a board that is not part of the Supreme Court has the potential of being unconstitutional. So I just wanna see where the committee is in terms of this bill. And do we keep working on it? Do we do changes, or do we just keep it up on hold? [Vice Chair James Gregoire]: I I can I can start up? I can take a good temperature of the committee. I don't think there's appetite. You can correct me if I'm wrong. Pursue this particular bill. I'd like to keep the conversation going about security in buildings, which I I don't necessarily, like, means passing something this year. But I I had a thought, like, I was gonna see if maybe the commissioner and Steve would sit down. I don't I don't know if we have all the information that we need at this point, But I wonder if BGS would be interested in conducting an employee wide, maybe survey with the Department of Human Resources or something to just ask the basic questions. Do you feel safe in the current environment? You know? What would make you feel more safe? Mhmm. You know? Does this have an impact on how you do your job, this type of thing? And by getting that information back, I think we might get a more complete picture of what areas this affects. Personally, I'm less interested in the courts. I think they already have sworn officers in there often enough. Mhmm. I feel secure when I'm in a a courtroom, which I find myself in. So that that's just my thought. But I I really don't wanna drop the issue because it's very real in the minds of state employees I talk to that they're afraid. And given some of the events in town, I can't tell them that they're wrong. We took the tour. You know, you saw people sleeping underneath the doorways there. You know, if you're going into your workplace, could be pretty intimidating. Well, it could be completely harmless. You know? But [Chair Alice Emmons]: Oh, that's fine. I'm [Connor Casey]: also interested in continuing the conversation on secure parking lots as that came into the conversation again yesterday from Steve Howard. And then I just I just looked at the federal building in Burlington, and it doesn't look like an imposing sort of fence or anything, but it would keep people out, I think. I mean, that, again, to somebody's point, you know, anybody who wants to be in that parking lot is gonna find a way to get into that parking lot, but there is an immediate sort of I have to work to get into. So that that to me feels like something at least worth exploring, and it doesn't pervade into or invade into the purview of staffing the court security, staffing BGS security. But I and, you know, when I when we also see the the design plans for that whole area between the state buildings and the river, I would wonder what a fenced in parking lot would do to that plan, but I I think it's worth pursuing spending money on parking lots. James, is it true to go? [Kevin Winter]: Well, I started, like, with a really bad day because I gotta do the car. And I gotta agree with you. And I was just saying it's it's not a it's not a state parking lot situation. But when I think about this particular situation, it makes me really feel like the that that our parking lot should be as well. I always think of back in the day at Lakeside, not very long ago, Lakeside parking lot for, like, u UBM and stuff would use it. And so the nurses extended, but I was sad to be security because they were constantly getting that down there and and accosted. And so that's not a state issue, but it but it's app it can happen anyway. And so if our if our employees, which we're responsible for, feel that same kind of thing, whether it's real or imagined, it doesn't you know, If you feel unsafe, then I think we have an obligation to at least look at it and try to figure out, you know, ways to make it more safe in your your your offense. You're bringing up that fence issue, which made me think of that part. But I agree with Connor that, well, first of all, there's certain things that the courts I think that should just come out of the bill. But if it if it goes anywhere, they [Troy Headrick]: are already taken care of. [Kevin Winter]: But that the conversation between BGS and the the the union and having that survey of, like, well, not only do you feel safe, but if not, why and what would make you feel more safe? I think that's a good place to start to get some actual information from the people that we're purporting to do this for so that we're not just running off in the wrong direction and where it needs to be. But yeah. And outside, I think it's probably a bigger issue than inside for for most people. I mean, you go in a barcode at night. Yeah. You don't think so. [Chair Alice Emmons]: Yeah. Some other folks, Sean? [Shawn Sweeney]: I agree with everything that was said. And and I know, you know, Steve definitely had some valid concerns. So I my my thing is, you know, how do we hear how does we get him at the table more? And I liked what you said about him speaking with Wanda, you know, just to just to keep that you know, because it sounds like there are some people who are who are worried or concerned. So I I do wanna you know, but I feel like EGS is doing a really good job with it, and maybe we just need some fine tuning to it. And an ounce of prevention with, like, a fence, like, what what Troy showed me from Burlington, it was a pretty fence, but it keeps people out, and that could be hugely helpful. [Chair Alice Emmons]: So Troy, if you could bring up that picture, and then I have some thoughts on other pictures [Troy Headrick]: that you can bring up. [Connor Casey]: Sorry. Can you I'm gonna add something for that. No? [Chair Alice Emmons]: But Will, did you have your hand up? Will and then Yeah. [Will Greer]: One thing that was mentioned yesterday with the SCA was that, you know, they get told things that they wouldn't say to their employer. So What do you mean? Well, just that, you know, they would come you know, employees of the state would go to VSEA with very different perceptions than they would go into the state to report things. And so while we're talking about getting data from the state, which I agree with, I don't think that there's necessarily a rush. I mean, I I think we could, you know, move forward with it in some ways, but I there's no rush necessarily to, you know, butcher it and get it wrong. But if we were to collect data from the state, I also think it would be interesting to get BSEA's perception as well if they could do a survey and kind of match up Mhmm. What both find. Because if they both find the same thing, then we have a very honest picture from two very different sources. But if we get very different information from BSEA or the state, then we know that there's there's some [Chair Alice Emmons]: of the questions for us. [Vice Chair James Gregoire]: Yeah. I I I haven't seen it lately, Will, but there have been examples of BSEA and the state doing joint surveys there. So you have the trust factor. [Connor Casey]: There we go. [Vice Chair James Gregoire]: And it helps the conversation naturally when they sit down and formulate those questions. Then everybody's singing the same tune when they come in. And there's one thing like, okay. Maybe I'm just hearing from a handful of employees in my district if I get the bigger picture. It might paint a different story. I don't know. Yeah. [Connor Casey]: That's a great idea. [Will Greer]: If they move forward with that, then I think that Yeah. [Troy Headrick]: I was disturbed that there's a lack of trust, which is typical, alright, between the union and management. And so if they just sit down together, I don't think it's gonna be productive. I think if there's somebody from our committee sitting with them, it's sort of like VINES and using the VINES system. So that's the one thing. And then the second thing is to take the very complex system that BGS has already got and just throw it up in the air and have some committee start managing it. That is totally wrong. And we don't have the money just to start throwing into it anyway. So I like the idea of the survey to get as much real information as possible, but the animosity is that's a problem right now. [Vice Chair James Gregoire]: But what you don't wanna do is shut down the conversation. That that's that's because it festers if you don't. Yeah. [Troy Headrick]: No. I agree. We need we need genuine conversation, though, because right now, what we've got is two sides Yep. Pointing finger at each other. [Chair Alice Emmons]: Brian? [Brian Minier]: I guess it's two questions. One, I hope is fairly simple, which is how many parking lots are we talking about? [Chair Alice Emmons]: Well, this is what I wanna get to. [Connor Casey]: Okay. [Chair Alice Emmons]: Okay. Because I know my state building in Springfield. There's other state buildings, Bennington, St. Aug well, St. Albans, you're different because you're part of the TIF district. [Connor Casey]: Yeah. You're part of a really shady park. You're right. [Brian Minier]: You're going to I won't go [Chair Alice Emmons]: on it. Well, so if we could focus in on the one that was seen yesterday. This is for which building in [Connor Casey]: Federal building. [Chair Alice Emmons]: The federal building. [Connor Casey]: So this is downtown Burlington. Okay. Lake is to the left. [Troy Headrick]: Yep. This is [Connor Casey]: Pearl Street. These are the pods. The zero street in Melba. [Brian Minier]: Pods. Yeah. That's the pod. That's the homeless pods. [Connor Casey]: Here's the federal building with sorry. Sorry. [Chair Alice Emmons]: Right near one zero eight. [Brian Minier]: Well, and you can see, yeah, [Connor Casey]: you can see the parking lot that surrounds it. [Chair Alice Emmons]: And there's a fence all the way around there? [Troy Headrick]: It's pretty large. [Brian Minier]: Yeah. Yes. [Connor Casey]: So there's the fence around the federal building. [Chair Alice Emmons]: Is there a secure entrance that they Yeah. Guard? [Brian Minier]: The vault [Connor Casey]: is around the corner, which always makes me sad when I see it. [Brian Minier]: It's sort of what what's both? [Connor Casey]: So there's the gate that for exiting, I think. My favorite. I mean, I've never been in there. I've I've never been in there. [Chair Alice Emmons]: So is is there a card access, you think? [Connor Casey]: Yeah. There's a card access. There's a booth. [Chair Alice Emmons]: So how does the public get in? The Is that open to the public or just [Connor Casey]: These are employees. [Shawn Sweeney]: I think has to go into the front door. [Kevin Winter]: Yeah. Even if they're serving jury duty [Connor Casey]: And then you get scanned. I'm gonna go around to the front of the building. But you can see the fence surrounds the entire building. [Chair Alice Emmons]: So where does the public park? [Connor Casey]: I'm gonna street parking where they can [Chair Alice Emmons]: come in. [Connor Casey]: Garage or wherever they can. [Chair Alice Emmons]: Absolutely. [Connor Casey]: There's a bunch of there's park street parking right here. Yeah. And the post office as well. There's the post office. Right. Right. So a lot of people [Shawn Sweeney]: into the post office and go through security there? [Connor Casey]: Yeah. And then there's there's an entrance over here too. [Troy Headrick]: There's a street [Connor Casey]: over there. Never give me a star sign. There's an entrance. Right? You can deny the entrance. Sorry. Like, sign my sheet. Yeah. There's the entrance to the federal bill. [Chair Alice Emmons]: The thing they want to shoot anybody coming out the back for employees that could climb the fence. [Brian Minier]: These could. Yeah. That's right. [Connor Casey]: You can see they've added they added these two. I can't remember when that I remember it happening, but I don't [Brian Minier]: remember where [Connor Casey]: it was. Was mostly post the nine eleven stuff. Yeah. [Chair Alice Emmons]: So let's go to Springfield State Office Building. That's on Mineral Street. That one is designed a little different, and that will give folks a different perspective. [Shawn Sweeney]: Springfield That's what I was saying, Mary. It's like if someone wants to do some harm to somebody, it's really hard to [Chair Alice Emmons]: Let's go to Springfield because that will give you a whole [Shawn Sweeney]: That would make [Will Greer]: people feel better. [Connor Casey]: Does this sit right here? [Chair Alice Emmons]: Down a middle street. Yep. Go down a middle. [Brian Minier]: You take out the random. [Connor Casey]: You know? This yeah. You this is what we're looking for. Yep. [Troy Headrick]: This is interesting, though. [Chair Alice Emmons]: So if you can I don't mind? So the street there, Mineral Street would come in. [Connor Casey]: Yep. Okay. I don't have access to it. I tell you, in in in in testimony, Steve brought up the issue of, you know, teleworking yesterday. [Chair Alice Emmons]: Well, it's easier. It's easier It's [Connor Casey]: actually a bigger problem. [Chair Alice Emmons]: Troy, if you could go back to where you were inspected. [Mary A. Morrissey]: If you [Chair Alice Emmons]: could well, yeah. So if you go down Mineral Street, you see where Mineral Street is on the Yeah. Right in there? Yep. To the right of that is the building. Mhmm. Okay? There's parking there in the front. Okay? And there's a little bit more to the right as well for parking. Now, if you cross Mineral Street, there's the stairs. [Connor Casey]: Oh, yeah. [Chair Alice Emmons]: There's the parking as well for state employees. [Connor Casey]: Good luck. [Chair Alice Emmons]: So try fencing all that now. [Kevin Winter]: Absolutely in the woods. [Chair Alice Emmons]: No. It isn't. Not really. Not much because you're it's just got two trees. It's not much of wood. [Kevin Winter]: Well, it's true. [Speaker 9 ]: That's what they [Chair Alice Emmons]: do not see it. But it's down by the river, and the security there was concerned that employees are parking down there and then having to walk up that little road up to Mineral Street and cross or walk up that stairway. So what they have done is if there is a DCF or employee that's being threatened [Troy Headrick]: Mhmm. [Chair Alice Emmons]: They have made sure that they park near the building. [Connor Casey]: You can hear it. [Chair Alice Emmons]: But if you're fencing, look at fencing that. [Connor Casey]: Academy You also have parking [Brian Minier]: the academy. [Chair Alice Emmons]: You also have parking for state employees there on the right hand side [Connor Casey]: Yep. Yep. [Chair Alice Emmons]: Right in there. Mhmm. All of that in there. [Connor Casey]: And you could construct a fence that goes down here, down here, and across here. It's not necessarily attractive. But [Shawn Sweeney]: You could do yeah. But then, like, through the trees and stuff, Troy, it'd [Connor Casey]: be tough to keep an eye on that. [Chair Alice Emmons]: So that's the Springfield one. [Brian Minier]: Yep. Mhmm. That's just one. [Chair Alice Emmons]: Yeah. Bennington. If you go to the Bennington state office building, that building is fairly new. And that is that's near where the vet's home is and where the court is. [Connor Casey]: Who needs a field trip? Who needs a field trip? [Brian Minier]: That is pretty amazing. Yeah. You're We wanna survey all of them. [Troy Headrick]: See you [Kevin Winter]: guys next week. [Connor Casey]: This is Bennington. [Chair Alice Emmons]: That's Bennington. So I'm not sure where all the parking is there. [Will Greer]: But It's all [Connor Casey]: the way. [Kevin Winter]: It seems like it [Will Greer]: could be fenced in pretty easily. I mean, I think outside of [Mary A. Morrissey]: along where the Chamber of Commerce is and across on both of those two Yeah. Around that kind of bend there. As you go into the courthouse, there's some parking there. And then on the side where it says deer conservation, there's a few in there. No. I'm just And out to the side [Chair Alice Emmons]: and destroyed the other building. [Shawn Sweeney]: Well, you guys have a [Troy Headrick]: beautiful building. Let me [Chair Alice Emmons]: tore it down. Because I had problems with sarcoidosis. [Vice Chair James Gregoire]: It's much better than the old building. [Connor Casey]: Yeah. I wouldn't tore that down. [Chair Alice Emmons]: I smashed a window in the old building. Yeah. [Troy Headrick]: Did you? [Chair Alice Emmons]: We had the groundbreaking for the new building. I smashed part of the window and part of the wall. [Vice Chair James Gregoire]: Those were modulars forever and ever. No. [Chair Alice Emmons]: It wasn't. It was a real building. Oh, with [Vice Chair James Gregoire]: the real building? [Chair Alice Emmons]: The Sacramento. Gave me a sledgehammer, and I just went right to [Connor Casey]: And people go to the [Vice Chair James Gregoire]: I I stood outside with a it's Matt Soup for a week there just to get the awareness. [Troy Headrick]: I think [Will Greer]: that's mostly employees part. Okay. [Connor Casey]: Because usually it's a way. [Mary A. Morrissey]: It's mostly the core folks. [Chair Alice Emmons]: See, that would be our defense center. [Will Greer]: And then [Connor Casey]: so, yeah, if you go that way, I don't drive [Will Greer]: over that part. Yes. They I think they all park there. [Chair Alice Emmons]: So that's wide open. [Connor Casey]: Boy, Megan, the genesis of these pictures, not all these parking lots are the same. Right? And I don't [Brian Minier]: and they're not all the same level. [Connor Casey]: I I would be more concerned if I were at Springfield staff staffer than Right. [Mary A. Morrissey]: Going down into that. [Chair Alice Emmons]: I've worked on lighting for that. They've also and as I said, if there's an employee that is being threatened, they make sure that the person can park near the building, and they they make an attempt to walk with an employee in and out of the building. [Will Greer]: With that room. Like When [Kevin Winter]: you think about something like security, you know, we all love trees and stuff, and I certainly do. But the more bushes and other stuff you have, the more danger. You know? So it's just a fact. [Mary A. Morrissey]: Well, the thing is is if you think the five hundred thousand dollar fence that was predicted for the mile end, Try covering Well, [Connor Casey]: we just saw eight figures worth of fencing. [Mary A. Morrissey]: Try covering this area. [Connor Casey]: It's a lot of money. Yep. [Chair Alice Emmons]: That would be a lot. [Connor Casey]: But but beyond that, if there it it might be good to start with some kind of survey, and you you could find out what the aggregate larger areas of concern are So instead of making solutions for people without getting their input. [Chair Alice Emmons]: So if we do that, which I'm thinking people are supportive of the first step, Can we have a couple members work with BTS and state employees? And I think, Hannah, you'd be one of the [Vice Chair James Gregoire]: best Yeah. I I'm happy to Is [Chair Alice Emmons]: there another member that would be willing to work? Sure. [Speaker 9 ]: Kevin, you [Chair Alice Emmons]: wanna do it? So Kevin and Connor, why don't you we can reach out to the [Vice Chair James Gregoire]: Steven Wanda. [Chair Alice Emmons]: Steven Wanda and see if we could just set up. [Troy Headrick]: I I'd be curious. Has there ever been a concept of, like, the first alert kind of thing? Those employees that are not feeling safe to have an electronic security button that says, I'm not something's going on here, and they hit the button and someone is available to go to the [Chair Alice Emmons]: That would have comment saying It's interrupting. [Troy Headrick]: Yeah. We have those. Seriously. So so that somebody could [Vice Chair James Gregoire]: could take care [Troy Headrick]: of the ones who are concerned. And then there'd be someone who responds immediately. [Brian Minier]: Well, the reason I'm the president, [Connor Casey]: we have those credentials. Side of that button. Yeah. Yeah. You could [Chair Alice Emmons]: do it with your iPhone. Put it there. Well But that's a conversation to have. [Vice Chair James Gregoire]: And the the other thing you see on college campuses a lot is the lit phones in the parking lot that you can you know, that's a Yeah. [Connor Casey]: I just got rid of theirs. [Vice Chair James Gregoire]: Watch. Really? [Brian Minier]: It's a problem. Yeah. [Troy Headrick]: But but that's that's a hard spot. [Connor Casey]: If they've got it on their body They haven't had it. [Troy Headrick]: And they're walking and they see something they don't like, they can ask for help. Or [Chair Alice Emmons]: they're interviewing someone, and they're in a room with anything. [Kevin Winter]: But you also get into the point, not get too far into security, that one of the biggest things that affects being attacked is that people aren't paying attention. Their noses are in the phones. They don't see anything coming. They're not aware of their surroundings. Right. So it's a whole there's a whole bunch of we're gonna start with the survey, like [Vice Chair James Gregoire]: survey. Yeah. [Chair Alice Emmons]: So we'll do that. We'll just temper it. We'll keep this bill on the wall and not do any more work on it this session. [Kevin Winter]: Right? Agreed. [Troy Headrick]: Okay. I also [Brian Minier]: have the second question. [Troy Headrick]: Oh, [Connor Casey]: yeah. Sorry, Randall. Sorry, Brian. Two. You missed the train. It [Brian Minier]: may be for Connor. It may be for you, but partly, there's this perception of being unsafe, but it seemed there is also a perception of just not being listened to. And so I'm wondering what the feedback how that happens now. Like, how do you say I'm feeling unsafe? Who who does it go to? What is the process? [Chair Alice Emmons]: VSEA. Yeah. They're hearing it more from VSEA. It's it's that tension that we talked about that you can go to VSEA, but they're not gonna tell management. [Vice Chair James Gregoire]: Yeah. It's why I like the idea of a joint survey really. You know? Yeah. I like [Connor Casey]: that too. Yeah. Okay. I just have one more idea I have [Shawn Sweeney]: to throw out here. I just thought [Connor Casey]: about it. [Chair Alice Emmons]: You're not building [Brian Minier]: Around everything. This is [Troy Headrick]: a snake. It's [Brian Minier]: a one trick pony. [Kevin Winter]: I was saying. [Shawn Sweeney]: No. But instead of just walking people to their car, maybe the the the guy can go out and grab a car for someone and bring it up. I know that's like I know I'm it's like ballet. No. But, look, but that would make like, if I was someone who was feeling a little threatened, instead of walking out to the car at a at night, have someone go grab the car. I mean, to someone it's not a lot [Troy Headrick]: of people. It's probably two or three people at [Shawn Sweeney]: night, but have them get the car, bring it up, and then get in and go. [Chair Alice Emmons]: But if you're thinking of the distance from the door of the building to where they walk to the car Okay. If I think of Yeah. What I'm aware of, it wouldn't take much to [Shawn Sweeney]: I know. Well, like I said, [Troy Headrick]: when someone wants to do it They're gonna do it. You're Exactly. [Chair Alice Emmons]: You know? So [Connor Casey]: So I'm just saying [Chair Alice Emmons]: So maybe what folks could do So the your free time, go visit you have a state office building nearby. Yeah. Go visit it and and see what the layout is. Go into the building, see how it feels. You might wanna do that just to Do it [Vice Chair James Gregoire]: at night if you can. It's a, you know, it's a whole different parking lot at night. [Troy Headrick]: Yeah. Are are there any government buildings that are second shift? No. Well, you [Vice Chair James Gregoire]: know, they I think [Troy Headrick]: I know the answer is no. I wouldn't think so. [Vice Chair James Gregoire]: You know, like, you you have cases where the offices are open. But usually, like, the second shifts are facilities like prisons, you know? [Brian Minier]: Yeah. Bless you. Bless you. Bless you. [Vice Chair James Gregoire]: Bless you, right, correctional. [Shawn Sweeney]: I mean, this place is still open when our car access at night. But Okay. [Chair Alice Emmons]: What is? The Capitol. [Connor Casey]: I don't know if it's gonna be something else. [Troy Headrick]: Yeah. But, [Vice Chair James Gregoire]: like, there's but there's none [Chair Alice Emmons]: you own me. The [Connor Casey]: best. Yeah. [Chair Alice Emmons]: I'm not talking. Yeah. Our own, but [Troy Headrick]: We have our own security person. I do [Vice Chair James Gregoire]: a lot of weird stuff. We're fighting for everybody. Very good. Okay. [Speaker 9 ]: I can't. For [Connor Casey]: you. You get it all out. Twenty four [Chair Alice Emmons]: So, you know, it might be a good thought just to go visit your own state office bill. [Mary A. Morrissey]: So many times. [Chair Alice Emmons]: That kinda opens up your eyes a little bit. [Troy Headrick]: Connor, it sounds like Connor has a down pat. [Chair Alice Emmons]: Well, he has a lot of topics. Okay. We've got Katie coming in at ten o'clock. Let's go over. We have a new draft. [Troy Headrick]: Did we get it? [Chair Alice Emmons]: For people who have paper copies. We're doing thirty two. It looks like this. It's on the web page. [Troy Headrick]: Yeah. If anyone wants to I [Connor Casey]: know you're creating copy. I have several. [Chair Alice Emmons]: So pull out your old copy because we worked out the old copy. [Will Greer]: What what draft version you think? [Chair Alice Emmons]: Well, this one is two point one. K. And the old one is whatever. Three point one step one. Three point one is the new Yeah. [Connor Casey]: You should not [Chair Alice Emmons]: Two point one is the is the new one. Gotcha. [Kevin Winter]: Got yellow highlighting on [Chair Alice Emmons]: it? One point one. It's on your desk. Right? [Connor Casey]: Point one for highlight. Yes. [Chair Alice Emmons]: I've got it. What I'm And one point one is the old one. They they got notes on that in terms of what needed to be changed. But I just wanna quickly go over it so we don't waste a lot of time with Katie. Nice. So and Troy and James and I sat down, went through what we had been hearing for changes Mhmm. To the draft, and we sent that off to Katie. And this is a result. So I wanna make sure we encompassed everything. So on page one, we updated the detainee Mhmm. Definition to include what is currently in statute for inmate. [Connor Casey]: We already moved. We also have new definitions to this point [Chair Alice Emmons]: in the To the front. Mhmm. [Troy Headrick]: Right. What's my preferred for that? [Chair Alice Emmons]: So it's individual confined during the pendency of a prosecution against the individual. That's what we picked up from the definition that's in title twenty eight for inmate. Health practitioner, the recommendation was that we, add acting within the individual's lawful scope of practice. So wherever the term health practitioner is used in this bill, it implies person is acting within their lawful scope of practice. K? On page two, this is in your regular medical care. It's the department or its contract. We want to put in put back its contractor. And we know that the contractor, Wellpac, is under the Department of If we just left it to the department, it's the contractor that does the work, not central office. So that's why we wanted to put that for its contractor. That makes sense to folks? [Vice Chair James Gregoire]: Yeah. That's all good. Yep. [Connor Casey]: I'm just momentarily confused here for a second. John McCall. Where are you at, Philip? Look at page one on the old on one point one. Yeah. It was Why did we switch from a and b to b and c? What is a now? [Chair Alice Emmons]: Well, because a is now the definition. [Connor Casey]: Yeah. Through the team. I gotcha. Thank you. [Chair Alice Emmons]: A we have the new a as the definition. So the old a becomes b. It should follow that, folks. [Connor Casey]: No. No. No. Okay. Go to one point one. Right. Right. [Chair Alice Emmons]: K? So on line, it's not [Speaker 9 ]: you got a. Yeah. [Chair Alice Emmons]: On one point one. Yeah. K? Then you go to b. Mhmm. If you go to the new draft [Connor Casey]: Right. [Chair Alice Emmons]: What is a? [Shawn Sweeney]: As you said, the subcontractor [Connor Casey]: is the now is the b. [Chair Alice Emmons]: So now a is your definition section. [Connor Casey]: Right. [Chair Alice Emmons]: If you flip the page, the new b is what the old a was. [Connor Casey]: Okay. Provision, Medicare oh, Medicare. [Chair Alice Emmons]: You're added a new section. Okay. Gotcha. [Connor Casey]: Okay. K. How do you [Chair Alice Emmons]: read a bill? So if somebody asks the question on the floor, you can answer it. [Troy Headrick]: Mhmm. Right? Delete or at [Brian Minier]: least give it a good shot. [Chair Alice Emmons]: So what so the sections were all renumbered. We put back or its contractor wherever it's head department we wanted to put back or its contractor. Then bottom of page four, top of page five, he deleted medically necessary because that definition is picked up on page one, line fifteen. If you go to page one, line fifteen, that's where medically necessary is for this subchapter. So that also would include MOUD. So wherever medically necessary is stated in the statute, it pertains to the definition on page one, line fifteen. [Troy Headrick]: K? [Chair Alice Emmons]: Mhmm. So, again, on page five, we're just dealing with the medical piece, not the MOUD. And we wanted to clarify on line fourteen what the word thereafter. This is for a person who, this is dealing with external medical contractors contracts. In any contract between the department and the provider of physical, mental health, or substance use services would establish policies and procedures for continuation and provision of medication at the time of admission. That's when a person comes into the incarcerated setting, goes through a booking, and before it said and thereafter. And the question was, what is meant for thereafter? Is that forever? Could it be when they're on furlough? Could it be when they're on parole? So we clarified that to say the time of admission and through release. [Troy Headrick]: And what that means is at least a twenty eight day supply? [Chair Alice Emmons]: No. Oh, well This is medical. No. No. I'm not Oh, twenty eight days. Right. I'm sorry. [Troy Headrick]: Yep. Any medications, That's that's what true release means is [Chair Alice Emmons]: Well, that's what I'm kind of It's not for six months, but it's one month. Yeah. Through release, it's That might need I wonder if it's more like upon reentry. Through release, would that go when they're on furlough? Through furlough? [Brian Minier]: Through I remember it coming up, and I was just concerned that to release doesn't cover the moment of release when you get the twenty eight days or whatever. [Vice Chair James Gregoire]: Mhmm. [Chair Alice Emmons]: Time of admission and at the time of reentry [Connor Casey]: Mhmm. [Chair Alice Emmons]: May be better. [Troy Headrick]: Are we talking us out through one thirty days after release? Is that what we're specifically talking about? [Chair Alice Emmons]: That's a time of reentering. So any contract let me see. See what that section is [Brian Minier]: Yeah. I think Kevin are trying [Connor Casey]: to convey, like, when they [Brian Minier]: get out, you give them their stuff. Good job. Exactly. You know? Yeah. [Connor Casey]: I wanna stop. [Brian Minier]: Wanna say that. Yeah. Yeah. Yeah. Yeah. [Troy Headrick]: Through release, how long is it release? [Connor Casey]: Yeah. Yeah. [Kevin Winter]: I need to circle out for another flag. [Chair Alice Emmons]: For continuation and provision of medication at the time of admission. So if you go to Kevin is saying the twenty eight days supply, which is the next section. Hi, Katie. Which is reentry fund. That would be a flag. [Shawn Sweeney]: We're already tearing it up. Sorry. [Chair Alice Emmons]: Yeah. It's just giving me a little head start. [Connor Casey]: You know what? I'm gonna just follow-up this team. [Chair Alice Emmons]: Okay. Proceed. What becomes I'll provide an offender with a twenty eight day, but, also, it's the contract the department of con would also look at setting up intake appointments. [Connor Casey]: So page so on page six line two, the not less than language. Went forward. Did you Right. Is that do we mean for that to be what's not more than? [Chair Alice Emmons]: Not less than. Means you [Connor Casey]: gotta So it could be a six month supply? [Chair Alice Emmons]: No. Not less than twenty eight days supply. So they do that, And then the next and it's may continue taking the medication as prescribed until the person is able to fill a new prescription. So the testimony we heard last year was they'll give them a thirty day supply. And the way that we heard about it last year was, well, they'll they'll leave with a prescription, or we'll call them a prescription for that thirty day supply. We said that's where the breakdown is. So if they could leave the facility with the medication that they needed in hand, and then you submit the new prescription. So that that those days in between and the time they're released to getting the prescription, they actually have the pills in their hands. This is regular medication. This is an MOUD. So we stayed within that thirty day that the contractor does. We had, on our side, two weeks supply of medication of pills. I believe we had two weeks. It was up to fourteen days. The remaining of that thirty days is through a prescription. The senate changed it to twenty eight days. [Connor Casey]: Nonetheless, that could be construed as is that it [Brian Minier]: Up to anything? [Connor Casey]: That it doesn't have a cap. [Chair Alice Emmons]: Not less than twenty eight, depending when they can refill the prescription. [Connor Casey]: Not more than [Chair Alice Emmons]: We didn't have a not more because Okay. The way that they operate, what we heard in testimony was WellPath will submit a prescription to the pharmacist that the person uses. And if they can't get on insurance immediately, at least they have medication until they can get that prescription filled. [Connor Casey]: So then it is intent for that to be, in some scenarios, more than twenty eight days. [Chair Alice Emmons]: I don't know if that was the intent of the senate or not. [Troy Headrick]: I think that's that that [Connor Casey]: is how it reads in practice. Like, a reasonable person would read it that way. [Chair Alice Emmons]: We could if people are concerned about that, we could bring in Wellpath and have them explain again how they distribute the medication. But they do it within it's always within thirty days. They don't go beyond thirty days from what we heard. It's thirty days of our voice. So Troy and Connor, you were here, I think. [Vice Chair James Gregoire]: Yeah. I did that. I mean, the conversation's coming back a little bit there, and I think we did talk about it and felt okay that they weren't gonna give, like, three months. You know? Like [Chair Alice Emmons]: It's to allow time for them to continue on the medication until they can have that prescription filled, and they send the prescription out to the pharmacist when they're released. Yes. But what we also heard in testimony last week, I think they sent them out with a voucher. That's what I've heard. Well, last year, we heard it was actual medication. This year, last week, we heard vouchers. [Troy Headrick]: Well, that's what I heard, and I thought we were trying to get it set up so we would get them reinstated into Medicaid. So if that was the case, why wouldn't why do you need the voucher? [Chair Alice Emmons]: Because that's the eleven fifteen waiver that doesn't kick in until January. And then that is to allow Medicaid coverage for them. And then that may what they're also working on in Diva is that instead of canceling their Medicaid coverage electronically, they wanna put a pause on it so that when they reenter, they can hit a pause button to reactivate. But that's an internal thing, uDiva. So right now, when someone reenters from an incarcerated setting, they have to apply or reapply for Medicaid. And that's where the hookup is because Mhmm. Some folks just don't know how to do it or don't know where to go or don't have access, or they have a very hard time comprehending. They have difficulty reading and understanding what's being asked of unless they have somebody to help. [Kevin Winter]: And as you know, somebody will fight you even if [Troy Headrick]: you have help. It was [Chair Alice Emmons]: Yep. It's tough. It's tough. So that's as far as we're going, Katie. I went through a little bit on some of the changes, didn't get up beyond page five. K. But you can start from scratch. Okay. K. They only heard it from me, so that we need our legal counsel. So and we have Tony Fallon on Zoom. So welcome, Tony. [Tony Fallon]: Good morning. It's nice to see everyone. [Troy Headrick]: Yep. Good morning. [Chair Alice Emmons]: Your dog is with you, keeping your neck comfortable. [Tony Fallon]: He he he enjoys the attention. [Chair Alice Emmons]: Yeah. I have a cat that does the same thing. [Kevin Winter]: So Sarah Sarah's very angry. [Chair Alice Emmons]: Yeah. I saw Kate Katie, why don't you just introduce yourself for the record? Katie McLennan office [Speaker 9 ]: of I'm gonna try to share my screen. First, I should log in to Zoom. I can't find that yet. [Shawn Sweeney]: Just a second one. [Troy Headrick]: You view that. [Speaker 9 ]: I I don't actually even have the link. [Troy Headrick]: Yeah. I know. [Chair Alice Emmons]: Oh, okay. So for the committee, this would be a good time to really understand what the words are saying and ask Katie. Because if we're gonna vote the bill out, we're getting close to really understanding what the bill says. Now would be the time. And there'll be a reporter of this bill. Somebody in this committee is gonna report this on the floor, and it's not me. [Troy Headrick]: I just smiled. [Connor Casey]: I wouldn't be able to say that. [Chair Alice Emmons]: Really important. [Connor Casey]: Getting there. [Speaker 9 ]: That's okay. While we're waiting, do you want to tell me you said you had some flags? Well, [Chair Alice Emmons]: I wanna wait till we get there. It's on Yeah. It's on page five. Okay. It's through release. I gotta [Speaker 9 ]: I don't know if you can do that. [Chair Alice Emmons]: Okay. That's the only one so far. Oh, there's the link. [31 seconds of silence] [Speaker 9 ]: Okay. Here we go. So we're looking at draft two point one. And as you have already seen, the changes have been highlighted. I'm trying to think through a few things that are happening in this draft. So I was given some edits to incorporate. One of the edits was to add or contractor. It wasn't added in all of the places that I added it. So I went through the draft and tried to think through, is the department doing this or possibly somebody else doing this? And I added it wherever I thought it would be the responsibility of a contractor. So pay attention to that as we walk through. And if it's wrong, let's flag it and correct it. [Chair Alice Emmons]: Mhmm. [Speaker 9 ]: One of the things that we talked about in the past month was how, because the statue has been added to over time, the definition section sort of ended up right in the middle of the statue, which is a strange place for it. So this version bumps it up to the top of this section. And as you see, it applies to the whole subchapter, so it applies to both of those sections that we're working on. So that applies [Chair Alice Emmons]: to both the medical care and and the MOUD? Yes. Got that, folks. [Speaker 9 ]: So the first change we have is detainee, and we're using the language that was indicated from DOC. Means an individual confined at a correctional facility during the pendency of a prosecution against the individual. And then with regard to healthcare practitioner, we're using language suggested by OPR means an individual licensed or certified by OPR or the State Board of Medical Practice acting within the individual's lawful scope of practice. There are no changes to medical necessity. Are you just wanting to go through the changes? [Connor Casey]: I think it would [Chair Alice Emmons]: be good to really go through the language because if we get to the point of voting it out, people need to know what it says. [Speaker 9 ]: So medical necessity describes healthcare services that are appropriate in terms of type, amount, frequency, level, setting, and duration to the individual's diagnosis or condition, are informed by generally accepted medical or scientific evidence, and are consistent with generally accepted practice parameters. Such services shall be informed by the unique needs of each individual and each presenting situation and shall include a determination that a service is needed to achieve proper growth and development or to prevent the MPSET of a worsening health care condition. And then medication for opioid use disorder has the same meaning as in Title eighteen. So notice that all this language is underlined even though it's actually existing language is underlined because we moved it to a new location. [Troy Headrick]: Yes. Just a question. Is it is it true that medically necessary is a subjective it's subjective rather than [Chair Alice Emmons]: Rather than objective. [Troy Headrick]: Right? Mhmm. So you could have two different doctors coming up with two [Chair Alice Emmons]: different prescriptions. Yes. But enough in the question. [Speaker 9 ]: This language is meant to put a lot many, I guess, guardrails around what we're talking about when we talk about medical necessity. You know, they're consistent with generally accepted practice parameters. So what are those practice parameters? So it's not a provider just sort of make making a determination with no guidance. [Chair Alice Emmons]: That's being guided. Guidance. And eighteen. [Speaker 9 ]: So they're informed by generally accepted medical and scientific evidence that's consistent with generally accepted practice parameters. So there the attempt is to put guardrails as to what we mean when we're saying medical necessity. [Troy Headrick]: Thank you. [Chair Alice Emmons]: I agree with with the attempt, [Troy Headrick]: but I'm hoping everybody understands that it's subjective. [Chair Alice Emmons]: Yeah. So, Katie, is medically necessary defined elsewhere in statute or in the health home? [Speaker 9 ]: I would have to double check. [Chair Alice Emmons]: I don't know off the top of my head. Such as [Speaker 9 ]: I know that we it's a phrase if not defined, it's a phrase that's used often in title eighteen. For example eighteen is for what? Health. I'm sorry. Title for example, you're gonna be looking at a bill on the floor tomorrow where it talks about medical necessity. So it's a term of art that's used within the health field. Yes. But if you want to know if there's a definition, I'd have to double check and confirm. [Chair Alice Emmons]: But within the health field of providing health care services, that is a term that is used medically necessary. Yeah. Okay. So we're not changing I mean, we're doing as what is on the outside of a correctional facility. We're making sure it is the same on the inside. I don't think medical necessity is a novel concept in this bill. [Troy Headrick]: No. But it is quite controversial, and we're not talking about operations or things like that at this point. But it's it's very object very subjective. That's my point. And as long as we all know that, even though we have guardrails, you know, which doctor you go to, There certainly aren't doctor shopping on the outside, so we just need to realize what we're opening up when we do this. [Speaker 9 ]: Ultimately, it's a contract. Ultimately, it's the well, I shouldn't say physician. Ultimately, it's the health care provider's decision. [Brian Minier]: That's where [Connor Casey]: I'm getting at. Within the context of this bill, medically necessary is always going to be determined by somebody acting within the scope of their legal Mhmm. Practice. [Troy Headrick]: Practice. Right. [Speaker 9 ]: Their their lawful scope of practice. [Brian Minier]: Lawful. Yes. [Connor Casey]: Thank you. [Chair Alice Emmons]: And it will be folks within WellCare or whatever contractor we have. [Kevin Winter]: And even though I just closed it out, if you search the term on Google, it'll be all kinds of medical organizations, and their definitions are all pretty much exactly the same as what medical necessity means. But they're all similar. Yeah. [Troy Headrick]: But they are there aren't many definitions of medical necessary. Okay. [Vice Chair James Gregoire]: It's actually not a Yep. Katie question, but it came up. Somebody wants a second opinion. Is there a process for that in corrections? Did we get an answer? [Chair Alice Emmons]: Oh. [Vice Chair James Gregoire]: I think Troy asked that I yeah. [Troy Headrick]: Like, I asked [Connor Casey]: I remember being here, but I don't remember what we did with that. [Brian Minier]: Yeah. I'm curious what that [Kevin Winter]: deal was. Yeah. I think I [Vice Chair James Gregoire]: have to follow-up with Yeah. [Chair Alice Emmons]: I don't yeah. [Troy Headrick]: And if if if if the incarcerated individual gets a no, it's not medically necessary, and they'd say, I need it. Can they get a second opinion? [Brian Minier]: Right. Right. [Troy Headrick]: That's where I asked the question. [Chair Alice Emmons]: Now [Vice Chair James Gregoire]: Well, maybe it was you who asked that question. Yeah. [Troy Headrick]: But you're right. The question was asked, and I don't think we did get an answer. But [Chair Alice Emmons]: You know, some I think you have to think about that within when they're admitted into a facility and what that process is for their health care. Because that's when it's determined if under what medication would be continued because the the contractor would be reaching out to that person's primary provider if they have one or the pharmacist that they are registered to validate that they are on that particular prescription. [Vice Chair James Gregoire]: Mhmm. [Chair Alice Emmons]: So the question then becomes, if they've been incarcerated for a while and they feel that something's going on and they need medication for that particular situation and the contractor says no, then what's the recourse? The recourse in corrections is filing agreements Mhmm. For that. Yeah. If they are if the health situation is such a condition where they are hospitalized, then it's what would happen in that world for that. I mean, that's the sound I'm thinking. We don't have corrections in the room, but that's kinda what I'm thinking with what I know, which is just enough to be dangerous. [Brian Minier]: He didn't review the grievance. Do you know that? I'm looking The [Chair Alice Emmons]: EOC reviews the grievance. I think it's done within that current fit within the facility. I don't think it's central office that does that. [Brian Minier]: It just sounds then like someone nonmedical could do reviewing a medical grievance. Right? [Chair Alice Emmons]: Yeah. I think that's the way it would work. We can get DOC at some point to come in and do grievance procedures because there's a lot of grievances that are filed for a lot of different things. So there is a definition of sorts [Troy Headrick]: Mhmm. [Chair Alice Emmons]: Medically necessary health care services. [Speaker 9 ]: Yes. So this is from title eighteen. This is [Chair Alice Emmons]: Title eighteen is Health. Health. It's corrections. It's health. It's a good book. It's title eighteen that covers health within our world, the outside world. [Speaker 9 ]: So this is a chapter on health care administration patient. So, this definition is specific to patient financial assistance, but the definition used here means healthcare services, including diagnostic testing, preventative services, and aftercare that are appropriate to the patient's diagnosis or condition in terms of type, amount, frequency, level, setting, and duration. Medically necessary care must be informed by generally accepted medical or scientific evidence and be consistent with generally accepted practice parameters as recognized by healthcare professions in the same specialties as typically provide the procedure or treatment or diagnosis to manage the medical condition. It must be informed by the unique needs of each individual patient and each presenting situation and must meet one of one or more of the following criteria, help restore or maintain the patient's health, prevent deterioration of or palliate the patient's condition, or prevent the reasonably likely onset of health of a health problem or detect an incipient problem. [Chair Alice Emmons]: So if you read the definition of what we have on the bottom of page one, and tracks this very well. Mhmm. If you read this while she was reading it Uh-huh. Attracts it very well. So that would be within the world of corrections, this language was picked up. Anybody follow that? Mhmm. So for these definitions that are in a, which is one is detainee, two is health care practitioner, and three is medically necessary, and four is medication for opioid use disorder. These definition apply to the two sections. The first section that deals with medical care and the second section that deals with MOUD. It does not apply to other parts of title twenty eight for corrections. [Speaker 9 ]: It applies to everything in that subchapter, but those terms are not for example, detainee doesn't show up anywhere else, so it only apply in those two sections. In In [Chair Alice Emmons]: the subchapter, is there anything else in the subchapter besides eight zero one, section eight zero one? Yes. In section eight zero one. Let me pull that up for you. I don't want for you. [Connor Casey]: We have a comb. Yes. The skin of our teeth. [Troy Headrick]: My concern is the expansion of this legislation to include other things that there is much controversy if I have whether it's medically necessary. [Chair Alice Emmons]: I think you're talking about trans or abortion. [Troy Headrick]: Right? As two major ones. There are others. End of life. [Chair Alice Emmons]: Well, they would have to have a directive for that. Understand. [Troy Headrick]: But I'm just saying, we're we're just yeah. That's all I'm talking about. Mhmm. [Brian Minier]: I mean, it occurred to me too, Kevin. I just don't know how you can constrain that. You have to go with the I don't agree. You know? I I don't know how you get around it. [Troy Headrick]: I agree. Except if the perspective on what's best for the patients are last testable to be checked. It's a totally different way of approaching the situation than how we're going. That that's that battle will continue. [Brian Minier]: Yeah. I just think we still defer to the professional organization saying like the individual provider does. Right? You know? [Troy Headrick]: Yeah. There's the [Brian Minier]: Yeah. If they say leeches, we're like, yes. Leeches. You know? [Troy Headrick]: Just one. [Brian Minier]: Yeah. Yeah. No. I dig it. [Troy Headrick]: I dig it. Yep. It's it's very subjective from that perspective. [Connor Casey]: Yeah. [Brian Minier]: Yeah. No. It's changing all the time, of course. [Chair Alice Emmons]: So what else is in this subject? So we know how these definitions are carrying through Yep. Elsewhere. It's there's a lot in there. Right? There is. Or would be carried through the whole thing. If it's used. Well, inmate is used. Twelve times. You don't have to find inmates. What's what subchapter is this? It's subchapter two. Subchapter two. [Speaker 9 ]: So it's pregnant inmates, correspondence of inmates, telephone use, exercise of religious beliefs, confer with counsel, counsel of inmate confined during, tenancy of prosecution, allowances to inmates, voting rights, temporary furloughs, treatment furlough, absconding from furlough, pardons, conditional pardons, work camps, denial of good time, restoration of reductions, appointment of agent, development of guidelines, visitation and recreation, inmate recreation fund, creation of work camps, intent earned time reduction of term. But if we do a word search within the chapter, it's gonna be slow. [Chair Alice Emmons]: Just wanna make sure we're not creating a problem elsewhere. Sure. [Speaker 9 ]: Detainee [Chair Alice Emmons]: is detained to any other facility. I don't [Speaker 9 ]: But, also, that I think that's outside the scope of subchapter two, that word detained. Detaining doesn't show up. Necessary. Well, this is the section that we're amending now. Right. [Chair Alice Emmons]: This is Yeah. [Speaker 9 ]: Name. This is the MOUD language. [Chair Alice Emmons]: Sorry. [Speaker 9 ]: Yeah. Same section. So it's only showing up [Chair Alice Emmons]: in those two sections. Really make sure that that that we don't end up changing something. Mhmm. For, like so detainee definition would only apply for section eight zero one and eight zero one well, I'm not sure I get the right number. B. And do you and you folks know what eight zero one is? Which is what? [Connor Casey]: Medicare care. I don't know what you do. [Chair Alice Emmons]: Eight zero one is what? [Connor Casey]: Medical care of inmates. Yeah. [Chair Alice Emmons]: And what's eight zero one b? BK. Eight zero one b. It's on page six. That's the map. I'm getting there. [Shawn Sweeney]: Substance use disorder. [Chair Alice Emmons]: MOUD. Yep. K. [Connor Casey]: K. [Chair Alice Emmons]: So the definitions one through four, they're applying to the just those two sections. [Shawn Sweeney]: Okay. [Chair Alice Emmons]: What page do we I think we're on page two. I just want folks to understand the moving pieces of the bill. Mhmm. [Speaker 9 ]: I would offer as an alternative if you're feeling nervous about the application of these definitions elsewhere, you could limit it. Instead of saying as used in this chapter, you could say as used in this section and section eight zero one b, then you would confine it to those two sections. That may be better to do that. Like to do that? [Connor Casey]: This way I talk to you. Mhmm. [Troy Headrick]: I'm sorry. I thought I was tracking you until this last [Chair Alice Emmons]: This last bit? [Troy Headrick]: This this last eight zero one b. I I You've done my watch tracking. [Chair Alice Emmons]: Okay. So if you go to line eight on page one Yes. It's medical care of inmates. Right. This is the medical care of inmates, and the bulk of it is dealing with regular health issues, not MOUD. Right. If you go to page six, the bottom of page six, line nineteen or line eighteen, you see section two. Uh-huh. Section two of the bill pertains to twenty eight VSA eight zero one b. Eight zero one b is substance use disorder. It's medication for opioid use disorder. So that's the MOUD section. So we got two two pieces here dealing with people's health care. The regular medical is under eight zero one Yep. And MOUD Yep. And eight zero one b. Right. [Troy Headrick]: I I do have that distinction, but I guess I lost you when you you I thought you were talking in terms of the use of the word detainee. [Chair Alice Emmons]: Oh, detainee would only be used for eight zero one and eight zero one b, not the rest of that subchapter. Oh. [Speaker 9 ]: So we're proposing a change on line nine of page one. Instead of as used in this section, we're gonna say sorry. As used instead of as used in this subchapter, we'll say as used in this section and section eight zero one b. Okay. So it'll be limited to those two functions. [Troy Headrick]: To just this document. [Connor Casey]: Yes. [Troy Headrick]: Yes. I got it. Thank you. [Chair Alice Emmons]: Make sure we don't screw things up in the other part of corrections. [Kevin Winter]: So as used in this section and eight zero one b. [Speaker 9 ]: And section eight zero one b. Two. Are we good? Okay. [Troy Headrick]: I'm sorry. [Speaker 9 ]: I'm gonna scroll right along to subsection b. So this is our provision of medical care. H two. H two of subsection b. The Department or its contractor shall provide health care for inmates in accordance with the prevailing medical standards. When the provision of such care requires that the inmate be taken outside the boundaries of a correctional facility wherein the inmate is confined, the department only shall provide reasonable safeguards when deemed necessary for the custody of the inmate where the inmate is confined at a medical facility. [Chair Alice Emmons]: This is where you added for its contractor where it was not Yes. In the previous law. Yes. Because right now, in the law, if you read draft one point one, eight zero one, provision of medical care, it says the department would provide medical care. K. I think in that particular case [Troy Headrick]: Understand. [Chair Alice Emmons]: In that particular case, it would just be the department, not the contractor. It's so dicey. Because [Connor Casey]: I'm gonna go well, Connor's [Chair Alice Emmons]: not here. I got Mary and Troy. We were very clear last year in terms of when someone is the least when they're reentering the community, that it is the contractor that prescribes the medication, gives the medication, and connects to set up an appointment with a a primary care provider or substance use, mental health program. [Connor Casey]: This isn't upon release, though. [Chair Alice Emmons]: I know. This is the whole medical care, and it shouldn't be the contractor. It should just be the doc the department. [Connor Casey]: Are they current when when the provision of such care requires that the inmate be taken outside the boundaries of the correction facilities, are we contracting with that new provider, the hospital, for example? [Chair Alice Emmons]: No. I interrupt you a con [Connor Casey]: Have we, though? Is there an overarching contract? I don't think so. [Chair Alice Emmons]: This is where we need the department. [Speaker 9 ]: I don't think that's about the medical care, though. I think that's about the transport and guarding of the person while they're at [Connor Casey]: I'll provide health care for inmates in accordance [Speaker 9 ]: That the first sentence, but the second sentence [Connor Casey]: When the provision of such care, which is health care [Speaker 9 ]: When the provision of such care requires that the inmate be taken outside the boundaries of the correctional facility, the department shall provide reasonable safeguards. [Connor Casey]: I get that. But I think the question here is, do we need the ORITS contractor in line five? And I'm saying that it's not necessarily the department. Hold on. Let me check the graphs. Do it. Hang on. Mars contractors shall provide? [Chair Alice Emmons]: Yeah. It's safer. They they need to provide correctional officers in the room. That's what that's saying. [Connor Casey]: Yes. So if a person [Chair Alice Emmons]: is going to a hospital for testing [Connor Casey]: Right. [Chair Alice Emmons]: Or whatever, they need to be accompanied by correctional officers. If they are admitted to the hospital, correctional officers need to be in that room. That's what eight, nine, and ten is saying. [Connor Casey]: Right. And we've taken out or as contractor in line nine. [Chair Alice Emmons]: Right. Because this But I [Connor Casey]: think it still applies in line five. Mhmm. Because that's we start talking about providing health care, then we switch to talking about providing security when health care is being provided in another place. [Chair Alice Emmons]: So we're really getting into the weeds on this one. That's what we're opening up here. [Kevin Winter]: And as we discussed the other day, well, three of us did, and I know the committee did from Katie's point of view. I believe is where it came from, but I agreed with is we don't, in any place, really need or as contractor because the department's no overarching thing, but then we agreed to put it in because [Connor Casey]: Well, what [Chair Alice Emmons]: if there was we were talking one specific two specific Mhmm. It was the twenty eight day supply Mhmm. When they reenter and setting up an appointment as follow-up. It could be with a doctor. It could be with a treatment facility. The same with MOUD. It is the contractor that gives that person the medication and then works to hook the person up with a hub. That's where we were really clear as the department or contractor. We weren't talking about these kinds of overall situations. We were very focused from the conversation we had in the committee last year in the language we put in for providing medical care on reentry or prescription as well as MOUD. So I hope Troy and Connor and Mary back me up because this is the work we did last year. [Brian Minier]: Well, I'm sure just to be clear, I think the hour before now is what is in the current draft of the bill. Right? [Connor Casey]: I'm not necessarily arguing for we added we readded the three of us or its contractor just to be explicit throughout the bill. Now we're wondering if we were over I think we're over protective or over or over cautious in doing so. My point right now, and I'm I'm not particularly attached to this, I'm just interpreting, is that just because it says or its contractor on line five doesn't necessarily, obligate the contractor to provide security. That's that's that's my point. I don't care if it's in or out because I think to James' point, the department is overarching enough. At heart here is whether or not we wanna be extra prescriptive explicit prescriptive throughout the bill. I don't know. I don't I don't I don't I don't I have a huge [Chair Alice Emmons]: What I would do is keep what we have in current statute for items such as b. Just keep at the department. But specifically for a person reentering with Medicaid, MOUD, that's where we add or its contractor. [Will Greer]: I can give [Chair Alice Emmons]: you my job. Say the doctor was added. Yeah? [Kevin Winter]: So it's confusing. [Speaker 9 ]: If you are adding contractor in some places and not in the other, it begs the question, does that mean the department is doing all of these tasks and not its contractor? [Chair Alice Emmons]: That could It's probably around around last year on that section. [Troy Headrick]: If [Kevin Winter]: it's all one way, it's easy to read. If it's mixed, it starts applying. In some places, only you can do it some place you [Speaker 9 ]: yeah. Who knows how a court would interpret it? I'm not a court. Right. But What's the legislative intent? Yeah. Is something different meant here because you didn't put contractor? [Mary A. Morrissey]: I think we have to have that because it says But [Chair Alice Emmons]: So then you get into redefine restructuring b because it's not the contractor that's gonna be providing security at the hospital. I don't think this I [Connor Casey]: don't think this states that it does. [Troy Headrick]: No. On line five, that's just saying they're gonna give the help No. [Chair Alice Emmons]: Seven lines. [Kevin Winter]: Well, yeah, that's where it [Troy Headrick]: should be. [Chair Alice Emmons]: That's what you were bringing up, Troy. [Connor Casey]: Right. We switch. We we we talk about the provision of medical care in lines five, six, and and then part of seven. [Speaker 9 ]: And then [Connor Casey]: And then we switch and we leave out contractor when it becomes the department's sole responsibility to provide safe reasonable safeguards. Perfect sense. That's how I interpret it. [Speaker 9 ]: What would you like changed? [Chair Alice Emmons]: Oh, it's not the contractor that was going to provide the security for the inmate when they are at the hospital. It is the department. [Speaker 9 ]: And I think it's It's it's correctional officer. Says it does it? [Chair Alice Emmons]: Or it's contractor. [Speaker 9 ]: No. I don't know. Well, they're two sentences. [Connor Casey]: Now down in nine, The department shall provide reasonable safeguards. The safeguards. Doesn't say contractor. [Chair Alice Emmons]: Right. [Connor Casey]: But I have a problem with real reasonable safeguards. [Chair Alice Emmons]: Well, reasonable safeguards is when is basically saying the correctional officers will be present. That's their safeguard. Whenever an inmate goes in out of out of a facility for medical care, they are accompanied by two correctional officers, by security. [Connor Casey]: And I I understand that, but I I I read this a bunch of times, and I didn't get that. So I I I mean, maybe I was just being, you know, I was being slow to the uptake on it, but I would I would suggest the department shall provide correctional officers. [Mary A. Morrissey]: I I [Connor Casey]: No. [Chair Alice Emmons]: I you can't you can't micromanage what the department's doing. Alright. That's fine. [Connor Casey]: I just wanted to say [Chair Alice Emmons]: some flexibility. And if we start doing that, they'll only have to get DOC in and really start taking more testimony in terms of how they provide security when a person is in the hospital. Because they also are having teams of folks now going out to take the pressure off correctional officers, being stationed at a person's hospital room. [Kevin Winter]: And also with the [Chair Alice Emmons]: And they have other teams, other folks who [Connor Casey]: are not correctional officers. Gotcha. [Kevin Winter]: And most reasonable in one case is not the other, so they need that flexibility. [Chair Alice Emmons]: And sometimes they've had field [Connor Casey]: officers, your P and P folks, transporting in Maine. [Chair Alice Emmons]: Your PNP folks, transporting inmates to a medical appointment and not correctional officers. [Shawn Sweeney]: As long as that's understood. I just didn't understand that. [Troy Headrick]: I guess for my education, line nine ten, isn't when deemed necessary a redundant phrase when you say provide reasonable safeguards? [Chair Alice Emmons]: That's up to how the department would do that because there may be some situations where it may not be deemed necessary that we're not aware of. I mean, this is language that's in law currently, and it was drafted based on testimony at that time. Yep. So I I don't know. I mean, maybe they needed more flexibility. I don't know. That's something we could ask DOC. [Troy Headrick]: I I I just wanted you you explained it. It's it's elsewhere. [Chair Alice Emmons]: I can't talk for what this has been in statute for quite a while, I would believe. And sometimes statute does provide flexibility because there could be times that things can't be carried out in a strict manner as we want. [Vice Chair James Gregoire]: You know, someone's in a coma, maybe only need one CEO. No. [Brian Minier]: It's your union. Yeah. [Vice Chair James Gregoire]: Yeah. But that's a kind of flexibility. [Chair Alice Emmons]: Yeah. Kind of flexibility. [Connor Casey]: Point taken. Yeah. Yeah. But going back to the original part. [Chair Alice Emmons]: So are we okay with b to add or its contractor? [Connor Casey]: Yes. Yes. Yes. [Troy Headrick]: Okay. Because we don't have that in line nine. Right. Right. [Connor Casey]: You don't want it in line nine. [Troy Headrick]: Correct. That's why I'm happy with it in line five. Totally. [Chair Alice Emmons]: K, Caitlin. Let's keep going. Okay. I'm on page two. No. We have [Speaker 9 ]: two subsections checked off, though. Okay. Subsection c, screenings and assessments. Mhmm. Upon admission to a correctional facility for a minimum of fourteen consecutive days, each inmate shall be given a physical assessment by a healthcare practitioner unless extenuating circumstances exist. Screening for all substance use disorder shall be conducted in accordance with section eight zero one b of this title. [Chair Alice Emmons]: Which is wonderful. [Speaker 9 ]: Yeah. So this language that's structured into, we decided to move it over to eight zero one b because it was more specific to substance use disorder. Mhmm. [Chair Alice Emmons]: So when a person is admitted for a minimum of fourteen consecutive [Connor Casey]: Mhmm. So we [Shawn Sweeney]: got testimony out. [Connor Casey]: Mhmm. [Chair Alice Emmons]: So a detainee who's coming in on Friday and leaves on Monday would be receiving a physical assessment? [Connor Casey]: No. They would receive a substance use disorder screening, but not necessarily a physical assessment or a full physical assessment. [Kevin Winter]: It's not, like, fourteen days? [Chair Alice Emmons]: They have to be there two weeks Mhmm. Before they get a physical assessment. [Connor Casey]: A full It is. What is it? Oh, yeah. Yeah. The [Troy Headrick]: the full one. [Chair Alice Emmons]: Yeah. [Troy Headrick]: Yep. [Connor Casey]: Got them? Yep. [Chair Alice Emmons]: Mhmm. Alright. That's [Connor Casey]: How did [Troy Headrick]: we come up with fourteen days? [Chair Alice Emmons]: Because of cycling through for detainees, those short termers. And it was just [Connor Casey]: Well, I think we've also heard that sometimes it takes two weeks for Mhmm. Everything to sort of settle in [Chair Alice Emmons]: Settle in and [Connor Casey]: before you get an accurate [Chair Alice Emmons]: Assessment of what's going on. [Kevin Winter]: It was that. It was obviously manpower. [Troy Headrick]: I was gonna say, if you could depending on your manpower or a lot of reasons, like, it may or may not be usable within fourteen. Yeah. That's I'm just asking the question. I'm not saying it's wrong. Yes. I understand. [Speaker 9 ]: Okay. At the top of page three, emergency care. When there is reason to believe an inmate is in need of medical care, the officers and employees shall render emergency first aid and immediately secure additional medical care for the inmate in accordance with standard set forth in subsection b of this section. A correctional facility shall have on staff at all times at least one person trained in emergency first aid. Mhmm. So it's important to flag I didn't add contractors here because we're talking about the officers and DOC employees often being the first person to identify that there's a medical emergency. Yep. Subsection e, policies. Right. The department shall establish and maintain policies for the delivery of health care in accordance with the standards in subsection b of this section. [Troy Headrick]: Mhmm. [Speaker 9 ]: Subsection f, preexisting prescriptions, definitions. Oops. We need to strike that because we don't have definitions there anymore. We moved them. It's definition for some type? Yeah. So we'll just put a period after prescriptions. [Chair Alice Emmons]: Okay. Alright. [Speaker 9 ]: Except as otherwise provided in this subsection, an inmate who is admitted to a correctional facility while under the care of a healthcare practitioner and who is taking medication at the time of admission, pursuant to a valid prescription as verified by the inmate's pharmacy of record, primary care provider, other healthcare practitioner, or as verified by the Vermont Prescription Monitoring System or other prescription monitoring or information system, including medication prescribed in the course of MOUD, shall be entitled to continue that medication and to be provided that medication by the department or its contractor pending an evaluation by [Chair Alice Emmons]: a health care practitioner. [Troy Headrick]: Mhmm. Very good. I don't [Brian Minier]: think I understand lines nineteen and twenty, medically prescribed in a course of medication for opioid use disorder. [Speaker 9 ]: So they're talking we're talking about medication that a person is taking with a valid prescription at the time that they're coming into a correctional setting. [Connor Casey]: Yeah. [Speaker 9 ]: And that could include medication that they're receiving as part of MOUD. MOUD, the term does not reply apply pertain only to the medication. The definition is that MOUD is medication plus any counseling type therapies that go along with it. So we're saying medication prescribed in the course of MOUD. [Brian Minier]: Course is that one? Okay. [Speaker 9 ]: Yeah. Which is sort of Seems weird medicine. Yeah. [Connor Casey]: Okay. [Kevin Winter]: Joy is so funny. [Chair Alice Emmons]: Try. No. [Connor Casey]: Natural can of worms. This is precisely I [Chair Alice Emmons]: thank you. [Connor Casey]: I know. But this is precisely the question that's posed to us by a representative Donahue. This is talking about admission. Yeah. But, the situation that representative Donahue presented to us yesterday was, an inmate being taken to the hospital, somebody at the hospital who has the scope of practice [Brian Minier]: Mhmm. [Connor Casey]: Is saying this person should be on methadone and is hitting a bit of a hurdle with the folks who provide the methadone. Yeah. That's right. You'll remember The hub. The hubs are Wellpath does not provide methadone, the hubs do. So this is all this is all getting tangled up in that. Now this is talking about admission, into a correctional facility. This isn't necessarily talking about a person who has already been admitted and has to go to the hospital for something and is going back. So there's, I just wanna identify that [Chair Alice Emmons]: There's a issue percolating it. [Connor Casey]: Yeah. And it I mean, it just it happened to pop up, you know, as we're talking about the very legislation that would have an impact on it. And I just don't know what we should do with that. [Brian Minier]: I don't see the problem yet, Troy. Can you say it again? [Connor Casey]: Yeah. So Representative Donahue, I'm just gonna tell the story. Representative Donahue came in this morning and said, Hey, you might have an answer for this. I got a text from my goddaughter, who is fourth year medical student, at the hospital, indicates that I've been treating and this is the second time this has happened to her now. I've been treating this person. I think this person should be on methadone. I wanna prescribe methadone. When I call BART, the hub nearest to Saint Albans, where this person is an inmate, I'm getting pushback. Don't bother. Now I'm worried that if I prescribe methadone, they're gonna be in withdrawal from methadone once they're re incarcerated because the continuity of care is hitting a hurdle. Does that make sense? Yes. [Chair Alice Emmons]: Because our hurdle is the hub needs to do prescription, not DOC Ah. For methadone. [Vice Chair James Gregoire]: Right. [Chair Alice Emmons]: Demand the ones that need to screen the person. [Kevin Winter]: I got the simpler version here, and that that made me look sorry. [Chair Alice Emmons]: Not not DOC. So we got Tony Fallon all of a sudden that came on. So, Tony, come help us here. [Tony Fallon]: Yeah. So for the record, Tony, following department head out division of substance use services. The fourth year I I'm I guess I'm a little confused. Under legally, other than an emergency situation or if somebody is subject to hospitalization and for a purpose other than opioid use disorder, It is unlawful for other prescribers to prescribe methadone for the course of opioid use disorder. [Troy Headrick]: So that's [Tony Fallon]: why methadone for pain, but it is unlawful outside of the outside of the hub, outside of the OTP to prescribe methadone for addiction other than there are two very simple situations. One is the person is hospitalized for a rationale other than opioid use disorder, and it is then determined and as the process there that the individual needs methadone as a as a sequelae, as a an adjunct. Yep. Or it can be done if the person is in imminent crisis at an emergency department. They can prescribe up to a total of three days maximum of methadone in an emergent situation to link the person over to the OTP. Outside of that, the the under the Controlled Substances Act, methadone can only be prescribed out of the out of the hub. [Troy Headrick]: That clears that up. Yeah. [Chair Alice Emmons]: Well, it makes you wonder what's happening here. So a hospital is not at liberty to all of a sudden prescribe methadone for opioid use disorder. Correct? [Tony Fallon]: Correct. If somebody presents in an emergency department and an emergency room physician says, I think methadone is what we want, they could prescribe up to a total of three days that is incumbent upon that emergency room to already have a coordination of care established. Because, again, it they it's called the the controlled substances act seventy two hour rule, and that is the maximum amount of time they can do it. If the person is an inpatient, I go in because I fell down and I broke my leg at work, and I need, you know, ball screws and and and all of a sudden I start to show symptoms of opioid use disorder and they say, yes. This person meets the criteria and we're gonna initiate it secondarily to during the hospital stay, then that's that's the only other time it can be done outside of a outside of a hub. [Chair Alice Emmons]: But they could do methadone in that particular situation? [Tony Fallon]: Up until the date of release. So, again and that doesn't encumber the the hubs who are really the only physicians who work exclusively with methadone to actually agree to that decision. [Chair Alice Emmons]: Yep. So the question would be in these two situations that came to our attention would be really working with DOC to see if the person is on MOUD to begin with. And if they are, what are they being treated with? It may not be methadone. And then when they're in the hospital for something else, the hospital may feel the person needs to be on methadone. But in order to really do that, they should be working through the hub. [Kevin Winter]: Yes. [Connor Casey]: So this sounds like to me there's and there are a few I I never like playing this game, Tony, so I apologize. [Tony Fallon]: Sure. No. No. Absolutely. [Connor Casey]: This is me hearing it from another rep who heard it from a practitioner. [Chair Alice Emmons]: Sure. [Connor Casey]: If a practitioner and I don't know the scenario by which this person would have arrived to the hospital. But if a practitioner is making a determination that methadone is best case for opioid use disorder, that's not necessarily an appropriate use of that person's, prescribed, you know, prescribed prescribing the prescription authority. Right? I'm sorry. I'm all tongue tied. [Tony Fallon]: So I I must You seem [Connor Casey]: surprised to to learn of the scenario, and that's because it may it might not have been an appropriate scenario to be in. [Tony Fallon]: Yeah. I mean, we are as part of a process, we are expanding trying to expand it or some emergency departments, the use of methadone for folks who come in and set up protocols and processes in place so that everything is set. But methadone has a significant number of drug drug interactions, and it also where practitioners understand the medical side of it, they may not understand that that's gonna encumber the person at least for a significant period of time to have to make daily trips to the clinic to do all of the the there's a lot of functional pieces as well, which is why, again, they have a maximum of only three days that they could prescribe it even in an emergency situation. [Troy Headrick]: So [Tony Fallon]: I I I I don't know enough about the scenario to say, why would we start the person on methadone in an an emergency situation rather than starting buprenorphine in the emergency situation, which provides a lot of flexibility, has less drug drug interactions, has a lot you know, it has a better side effect and safety profile, which is what most of the hub medical directors try to do, all things being equal. They say, you know, again, general medicine, we start with the better safeties side effect and safety profiles so that if we need to move up the class, we can move up to it, but we don't wanna do that if we don't have to. [Kevin Winter]: Hey, Tony. This is these limitations are federal law. Right? [Tony Fallon]: They are. They are DEA control the Controlled Substances Act. [Chair Alice Emmons]: K. [Tony Fallon]: So it's a weird again, it's one of those where you look at it for purposes of opioid use disorder. It can only be done out of a hub. If the person has pain and the expectation is the person would need methadone for pain, which is not widely used in this state, but is other states, that practitioner can treat pain with methadone. And part of that is simply the average dose for pain might be at twenty, twenty five, thirty milligrams a day. It's a a much lower dose. Because of the effects of fentanyl at this point, the average stabilizing dose for methadone and for opioid use disorder is a hundred and twenty to two hundred milligrams. So you're talking six, seven times the dose. Yep. And it is it has a a, again, side effect safety profile and a lethality profile that's much higher than than for Suboxone or or buprenorphine products. [Kevin Winter]: Yep. K. [Chair Alice Emmons]: So So the scenario that was playing out, which was a concern from a member that heard this, People person up with DOC to really work on that individual case to find out what was going on. So it may not be as it was relayed to us. Maybe a little different. But the concern was that it seemed like the hub was so backed up, they couldn't even do the screening and assessment for the person. That was part of the issue. And the other part of the issue was that this rest the resident was had come had come across this twice, and there wasn't a contact person in DOC that they could reach out to. Interesting. So those were the two real issues there. [Kevin Winter]: Residemic questions. Is it Vermont? [Chair Alice Emmons]: Yeah. UVM Medical Center. Okay. [Connor Casey]: That's up there. Saint Albans Correction Office. [Chair Alice Emmons]: In the Saint Albans Correctional Office. I mean, it's [Kevin Winter]: probably seen with research now, but based on Tony's testimony, like, it shouldn't be it shouldn't be an issue. Right. [Tony Fallon]: Certainly. UVM Medical Center is one of the pilot sites that we're starting to do methadone. They are doing it direct referrals to the Chittendon Clinic. So the medical director at the Chittendon Clinic, who also is the medical director at Bard in Saint Albans, is doing that in coordination with, UVM Medical Center. But, again, it's there's some nuances [Chair Alice Emmons]: as [Tony Fallon]: to how this is being done because of the the limitations of time in making sure these referrals can go direct. [Chair Alice Emmons]: So I think before we take any more time on this, I think, you know, we've put in place where there could be a this issue is being dealt with right now with DOC Mhmm. To really see what's happening. I would not touch anything in language at this point. [Connor Casey]: Agreed. [Chair Alice Emmons]: Let this kinda play out, see see where the communication there may just be a real lack of communication between all parties. [Kevin Winter]: Mhmm. Or miscommunication. [Connor Casey]: Just one more clarifying question. I don't know if I have it ready or not. Tony, are you do you have any worries about this legislation creating any sort of loophole by which a visit an inmate's visit to a hospital for whatever care creates a continuity issue that we're trying to close with this legislation? That that was a terribly worded question. I mean, do you understand my question, though? [Tony Fallon]: I I do understand the question. I do not have those concerns. [Chair Alice Emmons]: Okay. [Tony Fallon]: I mean, at this point in time, every facility every DOC facility, if the medical providers at the DOC facilities believe the individual would be better served by methadone, have arrangements with their local hub. So the treating medical providers right now are able to access methadone for patients if that or access the referral process. The hub medical directors ultimately make the decision on whether or not that is what they believe that to be the the best case scenario or whether or not there's a they would recommend a different medical intervention, but I I am not overly concerned. We have, in fact, had one prior where a person went to an emergency department as part of, the original booking. The orig emergency department gave them methadone, and what we actually did was because it was started at a very low dose, the determination was made between the patient and doctor Juhlinger that they would move the individual over to, Suboxone. Okay. [Chair Alice Emmons]: Alan? I'm [Troy Headrick]: sorry to do this to a speeding. I just do it. [Connor Casey]: I I started. I'll I'll take it. Yes. [Troy Headrick]: In the absence of Wellpath, [Chair Alice Emmons]: Well WellPath is the current contractor. [Troy Headrick]: Do we have any medical people who can prescribe Suboxone. Suboxone or some other DOC? Within DOC. [Chair Alice Emmons]: I don't believe so. It's the contractor. [Troy Headrick]: So then if we have a inmate on day four and they're there because they were caught stealing, but they were on heroin. They don't they don't get any heroin. [Chair Alice Emmons]: Withdrawal. Yeah. They're they're gonna withdraw. [Troy Headrick]: Up until day fourteen, They're not [Chair Alice Emmons]: No. I think they would intervene. It would be a medical situation. They would have to intervene. [Troy Headrick]: Well, that's what I'm seeing. Back on line one of page three, it only refers to the officers and the employees. They'll render emergency first aid. Seems like we're not in a position to take care of Yeah. That person who's incarcerated until day fourteen. [Tony Fallon]: My understanding, and please clarify with the Department of Corrections, but what we have historically done, and I believe that it is still the same process, was that those individuals would be initiated on medication via telemedicine. They might not get a comprehensive medical examination, but we would see that they're having what we would call cow scoring or clinical opiate withdrawal scoring. They would be scored, said, you as an individual right now are starting to experience withdrawal, and we would set that via telemedicine that they would go ahead and be initiated on buprenorphine, where then they might have to do the more comprehensive medical examination after the fact, but they are they were treating the individual based on the eruption of symptoms. [Chair Alice Emmons]: Let's keep going. No problem. What was that? Why Part [Speaker 9 ]: of the process. Okay. So we were in subsection f. Now we're that was subdivision one. Now we're in subdivision two. Notwithstanding subdivision one of this section, the department or its contractor may defer provision of a validly prescribed medication in accordance with this subsection if in the clinical judgment of a healthcare practitioner, it is not medically necessary to continue the medication at that time? [Chair Alice Emmons]: So if they come in with a valid prescription for one type of medication for, say, blood pressure, and then the department or a contractor can determine that it's not medically necessary for that particular medication or that particular disease. They could substitute a different medication. [Speaker 9 ]: Or they could discontinue it. Mhmm. [Chair Alice Emmons]: K. [Speaker 9 ]: Subdivision three, the health care practitioner who makes the clinical judgment to discontinue a medication shall cause the reason for the discontinuance to be entered into the inmate's medical record, specifically stating the reason for the discontinuance. The inmate shall be provided both orally and in writing with a specific explanation of the decision to discontinue the medication and with notice of the right to have the inmate's community based prescriber notified of the decision. If the inmate provides signed authorization, the department or its contractor shall notify the community based prescriber in writing of the decision to discontinue the medication. Subdivision four, it's not the intent of the general assembly that this subsection shall create a new or additional private private right of action. And then in subdivision five, we're striking through what had been our definition section because we moved it up to the top of this section. Subdivision, I have a question. [Shawn Sweeney]: Just and I know I've heard this, so I need to hear it again. So back on eighteen, number four [Connor Casey]: Eighteen. Page one eighteen. [Shawn Sweeney]: Yeah. Page four. So that this subsection shall create a new [Speaker 9 ]: It shall not. [Shawn Sweeney]: So I'm not creating [Chair Alice Emmons]: a new one. The intent. Right. So the intent of the general assembly is that the subsect subsection would not create a new or additional private private right of action. [Shawn Sweeney]: And the private right of action is? [Speaker 9 ]: An individual's so the state lawsuit, yeah, for the state. [Chair Alice Emmons]: Thank you. They've got taken off. Their medication was discontinued. [Speaker 9 ]: Okay. [Connor Casey]: Thank you. [Speaker 9 ]: Yeah. Subsection g, external medical provider contracts. I'm almost hesitant to say this. I was surprised that when I received your markup, we you didn't change external, so I didn't change it here. [Chair Alice Emmons]: It's pretty broad, though, isn't it? [Speaker 9 ]: Well, it just seems like when we were talking about it, we were external sort of has two meanings, and we were getting stuck in the fact that it had two meanings. So, the way I was thinking about it when I chose for the word external there was an entity a contract with an entity that is not DOC. And as I heard the committee discussing it, I heard some folks were, interpreting it as, like, physically outside a correctional facility. So separate from even the DOC contract. Mhmm. So I if there's if folks feel comfortable with [Chair Alice Emmons]: the use of external, we can leave it. I think it came up in the discussion about estate beds. Mhmm. Because we have a hundred and twenty inmates who are held down in Mississippi. Mhmm. And that's a separate contract. Mhmm. And within that contract, there's medical care that's provided. Mhmm. And it's not provided by DOC or Wellpad. Mhmm. It's provided down there in their world. And I think that's the context that we brought up the external medical provider contracts. [Speaker 9 ]: I think the meaning would you know, it had said third party medical provider contracts. I think it I think it had meant contracts a contract with DOC And an outside. But, like, not a third party, but the third party could be well path, I guess, is what I'm getting at. I don't know that the third party necessarily meant out of state. It just meant with an entity that wasn't DOC. [Chair Alice Emmons]: Mhmm. But I think what we ended up talking about as well was how does this how does the out of state contract in the medical care for our folks in Mississippi, how does that play out? [Speaker 9 ]: I asked EOC this question this week. Would you let I mean, does that take us down the wrong path? I can read the email if you're curious to hear it. It was helpful for me. [Chair Alice Emmons]: Yeah. Let's hear the because I think that's part of the context. We we brought that question up about the term external. [Kevin Winter]: Right. [Chair Alice Emmons]: Yeah. I have to put [Connor Casey]: up my email. Hang on. [21 seconds of silence] [Chair Alice Emmons]: So, Phil, do we have we confirmed anything with Jen Coleman if she's coming in at eleven thirty? [Shawn Sweeney]: She is would be available, but she's very happy to reschedule on another day so that we can continue this. [Chair Alice Emmons]: Yeah. Can we do her at all tomorrow? [Connor Casey]: I believe we can. [Chair Alice Emmons]: Yeah. [Connor Casey]: Okay. [Chair Alice Emmons]: She wouldn't be able to come in this afternoon after the floor because we might have some time. I don't there's not much on the floor, is there? [Connor Casey]: No. No. That's [Chair Alice Emmons]: Around two o'clock. [Shawn Sweeney]: Oh, I can ask. [Chair Alice Emmons]: Yeah. For sure. [Speaker 9 ]: This is from a staff attorney at, DOC because the the general counsel is not available this week. Hi, Katie. If housed out of state pursuant to our contract with CoreCivic or a similar contract, the department will typically require that the contractor comply with applicable state laws and its treatment of Vermont incarcerated individuals. For example, our current contract requires compliance with provisions of twenty eight VSA eight zero one B. That's the MOUD statute. But I believe that you're otherwise correct. The facility would need to comply only with applicable local laws where the contract is silent. [Chair Alice Emmons]: If house laws being down in Mississippi. [Speaker 9 ]: Yeah. So, if the contract doesn't, specifically speak to it, then the local state laws apply. If housed out of state another state agency the interstate corrections compact compact or the New England corrections compact provisions would apply unless the agreement with the other state was in effect prior to enactment of the interstate corrections compact statutes. The enabling statutes require that confinement in a receiving State shall not deprive any individual of any legal right which they would have had if confined in the sending state. Contracts made pursuant to the compact contracts made pursuant to the compacts generally indicate that an individual with a receiving state remains subject to the laws of the sending system. The only agreement I am aware of that does not contain such a provision is our agreement with the Bureau of Prisons. It is my understanding that it is not DOC's practice to send individuals receiving services to a jurisdiction where they are no longer able to receive those services. [Kevin Winter]: So in their contract, they have it already covered. Could it ask to go with it? [Chair Alice Emmons]: Say that again. [Speaker 9 ]: I'm sorry? [Kevin Winter]: In their contract, reports [Chair Alice Emmons]: Well, it won't be. Yeah. I mean For the other Yeah. The other part, the medical part, it could be for the what's required in Mississippi. [Speaker 9 ]: If it's not in the contract. [Chair Alice Emmons]: If it's not in the contract. [Connor Casey]: Cool. [Chair Alice Emmons]: So I think we go back to third party. [Connor Casey]: Okay. [Chair Alice Emmons]: Because I think external is so broad. [Kevin Winter]: Yeah. [Chair Alice Emmons]: And we Mhmm. [Speaker 9 ]: I mean, [Chair Alice Emmons]: I don't know if other committee remembers this, but I think the question came up about the out of state bed contract in medical care when he saw the term external. [Vice Chair James Gregoire]: Mhmm. I agree. [Chair Alice Emmons]: And I don't know if other folks remember that. [Connor Casey]: Alright. You're not here. Okay. [Speaker 9 ]: So I'll switch it back to third party. Mhmm. Okay. Any contract between the department and a provider of physical or mental health or substance use services shall establish policies and procedures for continuation and provision of medication at the time of admission and through release as determined by an appropriate evaluation by a healthcare practitioner, which will protect the health of inmates. So we were hung up on [Chair Alice Emmons]: the word through release because it's like how far through release? Because they can be released on furlough, back to the community. It's more at the time of reentry, that we were talking about. Right? If you want would like to say through reentry? For sure. Okay. [Troy Headrick]: K. Is reentry defined someplace? We're still wondering how long reentry is. Right? [Chair Alice Emmons]: Well, reentry is when they come back into the community. And it's they they have reentry planning. Reentry is when they physically leave the facility [Connor Casey]: That's what I was [Chair Alice Emmons]: back in the community. [Connor Casey]: Thinking through release from the facility. [Chair Alice Emmons]: Through release from the facility. [Connor Casey]: That's what I'm wondering. [Chair Alice Emmons]: That's what reentry is is when they're released from [Connor Casey]: Who do we just add from the facility there? No. I think that's pretty straightened. [Chair Alice Emmons]: Release from the facility. Because that's what it is. It's the pawn release. It's not continuing after they've reentered the communic. [Brian Minier]: Yeah. That moment's a last obligation. Right? Yeah. So yeah. And then it's [Connor Casey]: it's critical, you know, furlough question too. [Chair Alice Emmons]: Right. And parole. [Vice Chair James Gregoire]: And parole. [Connor Casey]: Yep. Does that feel like it stands out? [Speaker 9 ]: That that works, I think. [Will Greer]: Yeah. Mhmm. [Troy Headrick]: So there is there is a date. There's a final date for every person that's been incarcerated and released that they're no longer tied to the state? They're no longer the state's no longer responsible [Connor Casey]: for that? [Chair Alice Emmons]: The state is because they're under furlough. So they're still under the custody of the commissioner of corrections. But there's a reentry plan in terms of when the person goes on furlough because they're physically leaving an incarcerated setting to come back into the community. Right. So they're still under the custody of the commissioner of corrections, but they're in the community so they can function like you and I where they would go to their primary care provider. They would go to their local pharmacist. [Connor Casey]: Right. And their background checks. But [Troy Headrick]: but but is there is not a date at the end of furlough or parole? [Chair Alice Emmons]: There's sentence. [Troy Headrick]: What's that? [Chair Alice Emmons]: There's sentence. [Troy Headrick]: There's sentence. Right. [Chair Alice Emmons]: When it's done. [Troy Headrick]: So that's my point. And that could vary all over the place. It could be more than thirty days. It could be [Chair Alice Emmons]: Could be five years. Could be ten years. [Troy Headrick]: Yeah. Exactly. [Chair Alice Emmons]: Some people even they can serve their incarcerated sentence for a minimum, but they can be released on the minimum, but they have a probation sentence after that. [Troy Headrick]: Okay. So so my initial question that was thirty days or twenty eight days really gets provided here at all to the [Chair Alice Emmons]: Well, upon their when they reenter the community, whether it's on furlough, which most times it is furlough or parole, they need the twenty eight day supply of their medical medication, heart, blood pressure, cholesterol. They would have a twenty eight day supply when when they leave that facility. They'd be under furlough. Most cases, they would be under furlough or parole. And if they're a detainee [Troy Headrick]: shall establish If [Speaker 9 ]: they're a detainee [Troy Headrick]: but it's must include. Okay. I got it. Yeah. Nice. [Chair Alice Emmons]: It's that transition from an incarcerated setting to the community regardless of their status? A furlough or parole. [Speaker 9 ]: Is that section h prescription medication reentry planning? Except with regard [Chair Alice Emmons]: We're going to [Connor Casey]: Just from the facility. [Chair Alice Emmons]: From the facility. Okay. [Speaker 9 ]: Except with regard to medication for opioid use disorder, if an offender or detainee takes a prescribed medication while incarcerated and that prescribed medication continues to be both available, available at the facility and clinically appropriate I'm sorry. [Connor Casey]: No, no, you're getting it. [Speaker 9 ]: For the offender or detainee at the time of discharge from the correctional facility, the department or contractor shall provide the offender and may provide the detainee at the time of release with not less than twenty eight days supply of the prescribed medication. If possible, to ensure that the offender or detainee may continue taking the medication as prescribed until the offender or detainee is able to fill a new prescription for the medication in the community. The department or its contractor shall also provide the offender and may provide the detainee exiting the facility with a valid prescription to continue the medication after supply provided during release from the facility is [Chair Alice Emmons]: So, Katie, I'm wondering. As we have on the bottom of page five, at the time of discharge from the correctional facility, if that's not what we should use up on line fourteen [Speaker 9 ]: You want them them to match? Yeah. Instead of through release from the facility. Discharge from the facility? [Chair Alice Emmons]: At the time of discharge from the correctional facility. [Troy Headrick]: It's page five. Well, at [Chair Alice Emmons]: the bottom of page five, if you read, it talks about when a person is reentering the community. Mhmm. It says, line twenty one at the time of discharge Mhmm. From the correctional facility. If we pick up that language, we can put it up there. Yes, sir. Lines fourteen and fifth. It's con continuity. Yeah. [Troy Headrick]: Same same verbiage. In [Speaker 9 ]: subdivision two, the department or its contractor shall identify any necessary practitioner and schedule an intake appointment for the offender with the health care practitioner to ensure that the offender needs care in the community as part of the offender's reentry plan. The department or its contractor may employ a caseworker or contract with the health navigator to assist with scheduling health care appointments in the community. [Chair Alice Emmons]: Mhmm. That's our intent of continuity of care Yes. Once they reenter. And the person usually will be on furlough or parole. So this is only talking about the offender, not the detainee in two. [Connor Casey]: Mhmm. [Chair Alice Emmons]: Can we also include detainee? Or detainee? Yeah. [Connor Casey]: Is it a shell in maya again? [Speaker 9 ]: That'll be the in may. [Chair Alice Emmons]: Let's see. [Troy Headrick]: You do say they have line four. [Chair Alice Emmons]: Line four. [Troy Headrick]: Page six. Line four, defendant for detaining this [Chair Alice Emmons]: Right. It may provide the detainee. That is for when they come out. That's for the medication. And in terms of scheduling an appointment with a health care practitioner or, you know, just a health care practitioner. You have a prescription, and then it's that one deals with the prescription. And b deals with setting up appointments in the community to continue their care with a provider. [Speaker 9 ]: If it's helpful, your markup did indicate that you wanted detainees added to this parallel paragraph for MOUD, but it it didn't specify that here. So what I did in the language we'll look at is right here in between these two sentences for m o u d, I added the sentence. The department or its contractor may do the same for a detainee. [Connor Casey]: Correct. [Speaker 9 ]: So I could add that sentence there. Yep. Okay. [Chair Alice Emmons]: I think it was an August site on this. [Troy Headrick]: Yeah. I'll just pull it there. [Vice Chair James Gregoire]: Yep. [Chair Alice Emmons]: Okay. So we're done with the medical care. Yes. We're gonna shift when we go down to line eighteen, which is section two twenty eight b s a section eight zero one b. Now it's MOUD. [Speaker 9 ]: Uh-huh. K? Mhmm. K. So we're retitling this substance use disorder. And at the top of page seven, the that moved from the previous section. So, it's underlined, but it's not new language per se. It's moved language. It's jumped from one section to another. Within twenty four hours after admission to a correctional facility, each inmate shall be screened for substance use disorder by a healthcare practitioner as part of the initial ongoing substance use screening and assessment process, including screening and assessment for opioid use disorders. In subsection B, the Department or its contractor shall determine whether an inmate is currently using medication prescribed in the course of medication for opioid use disorder pursuant to Section eight zero one of this title. An inmate receiving medication for opioid use disorder prior to entering the correctional facility shall be entitled to continue receiving that medication pending an evaluation by a health care practitioner for as long as medically necessary. [Chair Alice Emmons]: So we are saying, on line a, an inmate receiving medication. And then you go to the definition of inmate, and we have and then inmate means and the general definition for title twenty eight could also mean an offender. It's a detainee and one who is sentenced. Mhmm. That's the term inmate means in this context Mhmm. Because we don't have offender or detainee. So the term inmate under general definition for Title twenty eight also means an offender. So this is someone All inmates include offenders, but not all offenders include inmates. [Connor Casey]: Mhmm. So This includes the offender and detainees. [Chair Alice Emmons]: And detainees. And all [Connor Casey]: the detainee is being treated for MOUD prior to arriving to the facility, they shall be [Chair Alice Emmons]: Yeah. But it says within twenty four hours of admission to the facility, each inmate shall be screened. So it's current language. The way we were looking at it last year, were we just thinking it was a person who was the detainee coming in? [Connor Casey]: This is I mean, this is precisely what we were doing with this. This is the continuity of care for somebody who is entering our facilities, either as an in as a as a detainee or otherwise [Chair Alice Emmons]: Or a person on furlough who violated. [Connor Casey]: Right. Is gonna continue to receive the continuity of care. That's what this was about. Even if [Chair Alice Emmons]: Using a different terminology than offender or detainee. Mhmm. [Connor Casey]: You're saying inmate. Yeah. [Chair Alice Emmons]: We're saying inmate. [Connor Casey]: Because it's an inclusive. [Kevin Winter]: If we are inclusive, it's the case. [Connor Casey]: I don't think you have to in this paragraph, I don't think you have to you certainly don't have to do a shall or a may because the intent is to provide that continuity of care even for detainees. [Chair Alice Emmons]: Oh, no. Sorry. Chat. So there is for folks under title twenty eight, which deals with corrections, there is a general definition section that defines what an offender is, and it defines what an inmate is. [Connor Casey]: And then this bill this defines what a detainee is. [Chair Alice Emmons]: Right. The detainee is not being used Right. In this line seven. [Connor Casey]: Right. So then by So you're [Chair Alice Emmons]: saying using inmate, you're going to the definition of inmate Yeah. Under the general definition of the title, twenty eight. That's how that plays out. Am I correct, Katie, or am I off base? Yeah. [Troy Headrick]: That's it. Which is what it likes. Right? [Chair Alice Emmons]: You wanna make sure that everyone who's coming into the facility within twenty four hours is screened. And we've got folks who violated their furlough. We've got folks who violated their parole who are coming in. The probation is a sentence. They would be called offender because it's the court that sends them back, sends them to an incarcerated setting. And then you've got folks who are newly arrested that have no other they're not under the custody of corrections or the courts. Those are your detainees. [Shawn Sweeney]: So are you saying this isn't working, Doug? [Chair Alice Emmons]: I'm saying that we have to be we know that the definition of inmate means it's also an offender and a detainee. Okay. So because we have defined detainees specifically for section eight zero one and eight zero one b only. It is not defined for the rest of title twenty eight. [Connor Casey]: You wanna find in May at the beginning of this amendment? [Chair Alice Emmons]: No. Because it's already in general definition. [Connor Casey]: Yeah. So Okay. We'll articulate, Tony, heads up, that this does again right. So this the question I've had all along is what if that medication being received prior to entering a correctional facility is an injectable? We we've talked about that. It's probably not likely. I just wanna identify that this is where that's gonna matter. And with yesterday's conversation with the other member, this is the potential loophole that gets created if an inmate is receiving treatment outside of the facility in a hospital and suddenly they're on a new medication that they want before. Again, I will articulate that that's probably unlikely. I just I'm only aware of the potential loophole because of the conversation, I was brought to this room by another member. [Chair Alice Emmons]: Mhmm. [Brian Minier]: Well, let's suppose that did happen when you get back to the facility. You're once again looking at well path considering what people have done outside. Right? [Connor Casey]: And they can make a decision to discontinue. Right. That's previous in [Brian Minier]: the bill. I mean, yeah, same as they did when they were first. [Connor Casey]: Yeah. I don't think I I just wanna identify that this is me being overthinking probably, but I just wanna identify this. [Kevin Winter]: I'm bigger concern. I thought we agree it's made for a purpose, and it seems like maybe [Troy Headrick]: there's questions about that now. [Chair Alice Emmons]: I'm not really sure. Sure. [Connor Casey]: I don't know [Kevin Winter]: if it was the right choice. [Connor Casey]: I agree. Yeah. I just I just wanna I I'm maybe I'm being way too I'm I'm just overthinking this to to a large degree. [Brian Minier]: No. It's a little messy, but I assume the same rule applies. Sorry, Tony. [Tony Fallon]: Yeah. No. I think it's I think it's a reasonable conversation to have. I think where where I think we are health care wise, where I think the struggle becomes is what we're describing is particularly thinking of methadone or an injectable of things that you have. They're traditionally specialty medical programs that we would initiate something in a place that without having a coordination? I can't think of a like, if I needed specialty medical care and somebody initiated that with the expectation I'd be able to do that in a day, two days, We just don't have follow-up like that for specialty medical care. So I think that is the the rationale on why we're trying to particularly work with all of the hospitals and the medical centers to say, you're referring this. You wouldn't start somebody on chemotherapy if an oncologist couldn't see the person within a reasonable time frame. You would have those pathways predefined, and I think that it does leave this as a susceptibility for anyone. Now hopefully, it's rare, but you've already seen one example of wanting to start a specialty medicine done under a specialty clinic that within a seventy two hour turnaround, being able to be seen by a medical provider not knowing all the details would be really difficult to get in to see a specialist in a three day period. [Connor Casey]: Yeah. [Tony Fallon]: So I think that it's recognizing what corrections responsibilities can be in this and recognizing that this is part of the struggle that we're still trying to work through in health care in general [Vice Chair James Gregoire]: Yeah. [Tony Fallon]: Of how do we get you know, somebody needs this or so this may be the appropriate thing. How quickly can we make it happen? [Kevin Winter]: Yeah. Okay. Good point. [Chair Alice Emmons]: So we I I got diverted, so I didn't hear the whole conversation. Are we okay [Kevin Winter]: Yes. [Chair Alice Emmons]: With Troy and Brian here? [Connor Casey]: We're good. I think we are. [Chair Alice Emmons]: I have [Speaker 9 ]: to be at another meeting. [Chair Alice Emmons]: I figured. [Speaker 9 ]: Could we should I flag that we have left off at sea and I could come back? [Chair Alice Emmons]: We've got what's your schedule, Katie? Because I really wanna keep working on this, Bill. Sure. [Speaker 9 ]: Let me take a look. [Chair Alice Emmons]: You have any time today while it's still [Speaker 9 ]: fresh. Probably [Chair Alice Emmons]: not ready. Have [Troy Headrick]: your time. [Chair Alice Emmons]: Let me take a look. [Troy Headrick]: Who do [Kevin Winter]: you need to talk to? [Chair Alice Emmons]: Let's see. Today is a global stay. [Speaker 9 ]: I could do I could come back three thirty to four if you wanna benefit then. Yeah. [Chair Alice Emmons]: Sure. That's when we that's when we have Eric. Oh, okay. Well, if it [Shawn Sweeney]: all works out, Jen Coleman at two, The side judges, that may take more than a half an hour at three if Eric is available and Katie at three thirty. [Chair Alice Emmons]: Put in three thirty. I wanna keep working on this while it's in our branch. Okay. If Eric can't make it till three thirty, we'll see when he can do them all. Because I wanna keep and how long do you have at three thirty? [Speaker 9 ]: An hour. [Brian Minier]: Like, seven or eight. [Chair Alice Emmons]: I I really wanna continue working on this because it's fresh in our minds. Okay. Because when we Yep. Stop and pick it up three days later, there isn't that continuity. And we really have to get through this draft because we still have to make some decisions. [Troy Headrick]: Mhmm. [Chair Alice Emmons]: And it might be good too, Phil, to get notice out to DOC that we're gonna continue conversations on h thirty two this afternoon. If anyone from DOC could be zooming in or in the room. Right. Because I need to be here as well. Right. [Connor Casey]: Thanks, Katie. [Speaker 9 ]: Thank you, Katie. Thank you. [Chair Alice Emmons]: So we'll pick this up at eleven thirty. [Connor Casey]: The thirties. [Chair Alice Emmons]: And see. Yeah. I I know we need a break because we've been sitting for a long time. So let's take a quick break and then come back. K. Okay.

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