Vermont Legislature SmartTranscripts:

[Representative Jill Krowinski (Speaker of the House)]: Will the house please come to order and members kindly take their seats? Good morning. The devotional today will be led by rabbi Grace Odell, is the executive director of the Northeast Organic Farming Association of Vermont.

[Grace Odell]: Good morning. I'm humbled to be joining you all on a solemn day, Yom Hashoah or Holocaust Memorial Day, which is the day of Yizkor of Remembrance. Today is one of deep mourning as we honor the 6,000,000 Jews who were killed in the Holocaust, babies, children, and adults alike. We also mourn the hundreds of thousands of Roma people, people with disabilities, queer people, political dissidents, and anyone that the Nazi regime deemed too other who also were targeted and executed. My own children lost half their ancestors in the Shoah. Together, we bear collective witness to this unspeakable horror of hate and state sanctioned violence. In Judaism, when we remember our ancestors, we repeat a phrase. May their memory be for a blessing. This phrase gestures toward the fact that memory is not static, but a living commitment that should inform the work we do, the policy we write, the change we dream of. We cannot grieve the Shoah and not notice the current dangerous patterns of dehumanization of whole groups of people. Who cannot shudder in recognition of what is happening around us today, Reading what Anne Frank wrote in her diary in 1942. Terrible things are happening outside, she wrote. At any time of night and day, poor helpless people are being dragged out of their homes. Families are torn apart. Men, women, and children separated. Children come home from school to find out that their parents have disappeared. Torah's words are not equivocal. Do not stand idly by the blood of your neighbor. Do not oppress the stranger. Love the stranger for you were a stranger. Torah is clear. Remembering suffering that befell our ancestors has always been entwined with a commitment to take action to prevent that suffering from happening to anyone else. These times are so hard and trying, but they also call us to find out how strong we can be, how to tap into a well of love and resilience that can never run out. I have seen our brave little state come together in solidarity and love before in ways that have moved me to my core, in the pandemic, but also in the floods with neighbors showing up to keep each other safe. The memory of the Shoah calls us to act every day from our most courageous, generous selves and to lead and make policy from a place of love rather than a place of fear. We can alchemize the grief of suffering into a fierce love for everyone around us and dedicate our lives to pouring love right back into the world, into our land, into our people, and into our shared future. Today, may we carry forward our collective mourning and remembrance and let us give let it give us all the bravery to act now with boldness, with courage, and with purpose toward the more loving world we know is possible. Thank

[Unidentified Representative from Bennington]: you.

[Representative Jill Krowinski (Speaker of the House)]: Will you please rise as page Graham Gilman of Moortown leads us in the pledge of allegiance? Members, we have two bills on the notice calendar that carry an appropriation and therefore are referred to the committee on appropriations pursuant to house rule 35A. They are house bill nine fifty five which is an act relating to next steps in transforming Vermont's education system. In senate bill 89, which is an act relating to expanding survivor benefits. Are there any announcements? Member from CALUS.

[Representative Marc Mihaly]: Madam speaker, it's with the greatest pleasure that I introduce Grace Odell who delivered our invocation today. Grace now serves as the executive director of the Northeast Organic Farming Association of Vermont, known to many of us simply as NOFA Vermont. I first met Grace when she was the executive director of the synagogue of Habi Zedek in Burlington. At the time, I was working with a group of NOFA board members seeking a candidate to undertake the difficult, if not the impossible task of replacing the irreplaceable and beloved Enid Wanagan who had essentially founded the Northeast Organic Farming Association and led it for several decades. So Grace was a candidate for the NOFA position and she did have agricultural credibility. She had founded and directed an educational farming center in Massachusetts and undertaken similar work in Maine. But Grace was up against candidates who had full careers in farming and farming policy. And while other candidates were farmers, Grace's then current position was as director of a temple in an urban area, not an obvious candidate to run one of the most important farming organizations in the state. Madam speaker, however, something in Grace's cover letter intrigued us. So instead of

[Unidentified Member (Older Vermonters Caucus announcement)]: a formal

[Representative Marc Mihaly]: interview, we arranged a video chat just to make sure that we weren't leaving out a possible candidate. After that one simple video conversation with Grace, we just knew without a doubt that we had spent an hour with an amazing human being, the obvious choice for the next NOFA director, and we were right. In the last seven years, the extraordinary Grace Odell has grown the organization, stabilized its finances. She is literally beloved by those who work for and with her. So, madam speaker, please help us welcome Grace Odell to the People's House.

[Representative Jill Krowinski (Speaker of the House)]: Will the guest member from CALUS please rise and be recognized? Member from Jericho.

[Unidentified Member from Jericho]: Thank you, Madam Speaker. As we heard earlier in the devotional, today is a day of remembering and a day of I didn't I didn't prepare remarks because this is an important so is very personal to me. I lost a significant portion of my family through the Holocaust. My grandmother left Poland as a teenager and went to Palestine to be there to help found the state because she knew, her family knew, that they weren't going to survive if they stayed in Poland, and in fact, she was the only one who did. There's a story that my mom tells that I will share with you all today. When my mom was cooking sorry. When my grandma was cooking, my mom would come into the kitchen sometimes and find her sobbing. And she'd say, what's wrong? And again, I'm gonna back up to a woman who left her homeland as a teenager, now has two young children and is cooking for a family in an incredibly difficult situation, very poor, very, you know, lucky to have the food that she's preparing. And my grandmother would say, I'm just chopping onions. And she used that chopping of the onions as an opportunity to let herself go and to feel what she was really feeling as alone as she was and as sad as she was. And at this time, remember, there weren't cell phones. There wasn't easy TV. She did not know what happened to her family, and she didn't understand completely as we do today because of these holocaust museums, because of all of the information that is shared, what really happened in Europe to her family. So today, we do have some folks from the Vermont holocaust memorial here with us. We have Deborah Steinman, who is the executive director, her husband, Peter, and Sarah Villanue, who is a board member with the memorial. And the Vermont Holocaust Memorial is an all volunteer nonprofit. It's a museum without walls dedicated to teaching the lessons of the Holocaust in classrooms and communities throughout the state by honoring the lives lost and sharing stories of survival. They envision a time where prejudice, bigotry, and hatred are replaced with respect for all.

[Representative Jill Krowinski (Speaker of the House)]: Will the guest member from Jericho please rise and be recognized? Members, because it is Holocaust Remembrance Day, will you please join me in a moment of silence? Are there any further announcements? Member from Hubbardton.

[Unidentified Member from Hubbardton]: Madam speaker, we have some visitors from from Orwell Village School. These future leaders are members of the student council taking tour of the capital. Leading the tour is a familiar face, former former representative Joanne Riano. So madam speaker, please welcome to the state house, Chandler Paquette, Rona Anderson, Cass Hunter, Clara Lucas, Zady Kirby, Joe Mason and chaperones Joe Adriano and Brian Hill, the sixth grade teacher and student council adviser. And they're seated up there in the balcony.

[Representative Jill Krowinski (Speaker of the House)]: Will the former member and the guest member from Hubbardton please rise and be recognized? Member from Bennington.

[Unidentified Representative from Bennington]: Madam speaker, I'm humbled each day that I walk in this building. Humbled not just by the grandeur of the state house or by the importance of the work we do here, but also by the incredible group of Vermonters with whom I serve. Right here in this room, we have lawyers and educators. We have farmers and Ivy League graduates. We have veterans and former state commissioners. And I believe, madam speaker, we may even have one rocket scientist. But for the past ten years, my poor father, asked what his son does for a living, has had to hang his head low and say, my son makes maple cotton candy for a living. Well, madam speaker, I believe that will change today for after visiting the people's house, I'm confident that the next time he's asked, my father will raise his head high and say, my son makes cotton candy for a living. But you should see how impressive his friends are. Madam speaker, if you'll help me welcome my father and brother to see us.

[Representative Jill Krowinski (Speaker of the House)]: Will the family member member from Bennington please rise and be recognized? Are there any further announcements? Member from Waterbury? Madam speaker, I move that house human services be relieved of h five seventy four, an act relating to the use and maintenance of epinephrine at childcare facilities and that the same be committed to the House Committee on Education. Member was that House Bill five seventy four? Yes. The member from Waterbury moves that the committee on human services be relieved of house bill five seventy four and the same be committed to the committee on education. Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. The ayes appear to have it. The ayes do have it. And you have relieved the committee on human services of house bill five seventy four and committed the same to the committee on education. Are there any further announcements? Member from Cambridge.

[Representative Lucy Boyden]: Madam speaker, the rural caucus will meet tomorrow morning from eight to 08:45 in Room 11 and on Zoom. We will be hearing from the Rural School Community Alliance and the Vermont Housing Finance Agency. All are welcome.

[Representative Jill Krowinski (Speaker of the House)]: Member from Wilkhardt.

[Unidentified Member (Older Vermonters Caucus announcement)]: Thank you, madam speaker. Tomorrow, the older Vermonters caucus will meet at noon in Room 10, and we will hear from two, we have two presenters, the state long term care ombudsman who advocates for the rights and quality of lives of Vermonters living in nursing homes and residential care facilities, and survey and certification director who oversees the inspection and compliance of Vermont's long term care facilities. Again, that's in Room 10 at noon. Thank you.

[Representative Jill Krowinski (Speaker of the House)]: Are there any further announcements? Members, I have an update for you on our calendar. So we will start with senate bill 163. We will then turn to house bill five zero eight. We have a committee who's still hearing an amendment on S218. So our order again will be S163H508 and then S218. After speaking with all house leadership, there's been a request to caucus. So after we hear the amendment and the straw poll votes on 02/18, we will then recess for caucuses. We will then come back, finish our work on s two eighteen. We will adjourn and then we will have our caucus of the whole to hear the ways and means, update on house bill nine fifty five or education transformation bill. Are there any further announcements? Seeing none, orders of the day. Members, we will begin with Senate Bill 163 which is an act relating to the role of registered nurses in hospital care. Bill was referred to the committee on healthcare which recommends that the house propose to the senate to amend the bill as printed in today's calendar. The member from Rockingham, representative Goldman will speak for the committee. Please listen to the second reading of the bill.

[House Clerk (unidentified)]: S one sixty three, an act relating to the role of advanced practice registered nurses in hospital care.

[Representative Jill Krowinski (Speaker of the House)]: Member from Rockingham.

[Representative Leslie Goldman]: Madam Speaker, S163, an act relating to the role of advanced practice registered nurses in hospital care was referred to the House Health Care Committee from the Senate and I respectfully report that it has considered the same and recommend that the House propose to the Senate that the bill be amended. The vote in your House Health Care Committee in support of this amendment was ten-zero-zero. You will find this bill on page seventeen forty six of today's House calendar. S. 163 is grounded in the Patient Bill of Rights and I would like to give a brief history of the Patient Bill of Rights. Before the nineteen seventies, the culture in medicine was that doctors made decisions with little patient input. Patients often were not told full details about their diagnoses and consent was minimal or informal. In the nineteen sixties and seventies social movements such as the civil rights movement, the consumer rights movement and the women's rights movement expanded into health care. Legal cases established informed consent as a requirement. There was growth in bioethics as a field, and patients began demanding transparency and participation in their care. The first formal patient bill of rights was in 1973 by the American Hospital Association, and it emphasized respectful care, privacy, access to information, and the right to refuse treatment. This was the first time patient rights in medicine were clearly codified in one place. In the nineteen eighties and nineteen nineties, HMOs and insurance companies gained power. Patients faced treatment denials, doctors had less autonomy and the public became more frustrated. In 1996, the Health Insurance Portability and Accountability Act or HIPAA codified privacy and control of medical records and in the 2000s hospital accreditation rules required patient's rights policies. In 2010, the Affordable Care Act expanded insurance protections. At that time, patients' rights became legally enforceable and not just ethical guidelines. Currently, health care emphasizes that patients are now seen as a partner in care, not just a passive recipient. Patients have digital access to their records through patient portals and there's an emphasis on equity and non discrimination with legal protections. The Patient Bill of Rights developed as a response to imbalances of power in healthcare. First between doctors and patients and later between patients and complex insurance systems. Over time, it helped transform health care into a more transparent, accountable and patient focused system. Title 18 chapter 42 sub chapter one codifies the Vermont Bill of Rights for Hospital Patients and Patient Access to Information. At the time of adoption in 1985, current practice was that physicians would be attending of record for hospital care. Over time, hospital practice has evolved to include advanced practice registered nurses and physician assistants in this role. Most notably in rural hospitals where physicians might not be available at certain times. S163 aims to update the patient bill of rights to reflect what is actually happening in hospital practice so patients will have a clear understanding who is responsible for their care be it a physician, advanced practice registered nurse or physician assistant. We learned in testimony that in actuality hospitals set their own admitting and discharge privileges. Medical staff policy at each hospital will be the arbiter of who is ultimately responsible for patient care. I will now review the sections of the bill as amended. Section one updates the definition of 18 VSA, Section eighteen fifty one of Advanced Practice Registered Nurse or APRN, Physician and Physician Assistant or PA. Section two adds PA or APRN to 18 VSA Section eighteen fifty two, the Patient Bill of Rights. Section A2 adds language that the patient shall have an attending physician, PA or APRN responsible for the patient's care. Section eighteen fifty two A3 states that the patient has a right to obtain from the physician, APRN or PA, coordinating their care complete and current information concerning diagnosis, treatment and any known prognosis that the patient can reasonably understand. If the patient consents, family members or guardians may also obtain this information. It also includes that the patient has the right to know by name the attending physician and now if passed the APRN or PA primarily responsible for coordinating the patient's care. Section 18.52A. Four states that in addition to physicians, APRNs and PAs may give information necessary to obtain informed consent prior to the start of any procedure, treatment or both. Section 18.52.8.9 and 11 state that the patient has the right to know the identity and professional status of individuals providing services and to know which physician, PA, APRN is primarily responsible for their care and has the right to continuity of care. Section 2b codifies that failure to comply with any provision of this section may constitute a basis for disciplinary action against the physician under 26 VSA Chapter 23 or 33, against the PA under 26 VSA Chapter 31 or against an APRN under 26 VSA Chapter 28. A complaint may be filed with the Board of Medical Practice or the Office of Professional Regulation as applicable based on the license held by the practitioner. Section 2C requires the hospital to provide contact information for the Office of Professional Regulation in addition to the contact information for the Board of Medical Practice. Any failure to comply with the patient's bill of rights can already form the basis for a disciplinary action for some physicians, medical doctors, but the bill expands that to apply to all physicians, including doctors of osteopathy, APRNs, and PAs. Section three eighteen VSA 19 o five five deals with licensing requirements for hospitals and states that a patient admitted to the hospital shall be under the care of a physician licensed pursuant to 26 VSA chapter 23 or 33, a PA licensed pursuant to 26 VSA chapter 31, or an APRN license pursuant to 26 VSA Chapter 28 Subchapter two. Section four is the effective date, which shall be on passage. After passage, the title of the bill will be amended to read An Act relating to the role of advanced practice providers in hospital care. Madam Speaker, in our current reality, especially in our rural hospitals, both advanced practice registered nurses and physician assistants might be serving as the attending from the patient's perspective. And s one sixty three aims to update the Vermont Patient Bill of Rights to reflect this reality. Witnesses include executive director, Vermont Medical Society, deputy chief counsel, office of legislative council, director, office of professional regulation, secretary of state's office, senior vice president of policy and strategy, Vermont Association of Vermont and Health Systems, Chair, Board of Medical Practice, Certified Nurse Midwife, American College of Nurse and Wifery, President, American Assistant excuse me, President, Physician Assistant Association of Vermont, Medical Director, Rutland Regional Medical Center, ICU, President, Vermont Nurse Practitioner Association. The vote in your House Health Care Committee in support of S 163 was ten zero zero and we respectfully ask for the body support.

[Representative Jill Krowinski (Speaker of the House)]: The question is, shall the house propose to the senate to amend the bill as recommended by the committee on health care? Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. The ayes appear to have it. The ayes do have it, and you have proposed to the senate to amend the bill. Now the question is, shall the bill be read a third time? Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. The eyes appear to have it. The eyes do have it and third reading is ordered. Next is house bill five zero eight, which is an act relating to approval of amendments to the charter of the city of Burlington. The bill passed the senate in concurrence with a proposal of amendment that is printed in today's calendar. The pending question is shall the house concur in the senate proposal of amendment member from Burlington.

[Representative Kate Logan]: Madam speaker, the senate government operations committee referred your house committee on government operations and military affairs, a proposal amendment regarding h five zero eight entitled an act relating to approval of amendments to the charter of the city of Burlington. They recommend amending section two, title 24 appendix chapter three section two, which proposed to authorize the city council to make changes to the boundaries of the election areas pursuant to this section to be made not more frequently than once every five years to now allow the city council to make changes whenever necessary to correct an unconstitutional division of population among city districts or wards. Madam speaker, Burlington situation is unique among Vermont's nine cities. The proposed amendment would still require voter approval of ward and district boundary changes in Burlington, but it would no longer require a charter change. This would facilitate the administration of city elections and would put the city on par with every other Vermont city and not requiring involvement from the legislature to determine board and district boundaries. Your house committee on government operations and military affairs found the amendment favorable on a straw poll vote of nine zero one and asked for the body support.

[Representative Jill Krowinski (Speaker of the House)]: The question is, shall the house concur in the senate proposal of amendment? Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. Ayes appear to have it. The ayes do have it and you have concurred in the senate proposal of amendment. Members, the committee I believe is still hearing the amendment. So we are going to take a brief recess and get an update on how much time the committee needs. So the house will stand in recess until the fall of the gebel at approximately 10:40