Vermont Legislature SmartTranscripts:

[Chair Matthew Birong]: Alright. Good morning, everyone. We are just down here after floor, shortly after 10:30 on Friday, January 23. And we have before us representative Casey Montpelier, and he is sponsor of h six twenty three, an act relating to licensure of massage therapists. So we asked him for a little introduction as we are discussing matters similar to what I believe is the same.

[Rep. Conor Casey (Montpelier)]: Good to see you, sir. Mister chair, committee members, it's a pure pleasure to be here today. Connor Casey, I'm, coming from the corrections committee. I often say it feels like, you're in prison sometimes in corrections because you don't get to see lovely rooms like this. You know? It's we have to do institutions. We should have built ourselves a nice one. But

[Chair Matthew Birong]: We operated ourselves a nice abode.

[Rep. Conor Casey (Montpelier)]: Yes. Well, it's good to be back. I've seen you before. My bill passage rate isn't great out of this committee, but hopefully we remedy that today. Right? It's I'm here to introduce h six twenty three, massage therapy licensure. This bill would make Vermont the forty sixth state in the country for licensed massage therapists. Right now, Vermont is only one of five that don't. And out of those five, we've got Kansas, Minnesota, California, all have bills pending currently there. So, those passed, Vermont's one of only a couple states there with the lowest level of regulation, registration, which it currently is now. So, why does it matter, this bill? When I talk to people, they're genuinely pretty surprised, I think, to learn that massage therapists aren't licensed in Vermont. We regulate many professions that involve far less physical contact, trust, and vulnerability than massage therapy actually does. Massage therapy involves unclothed clients, physical manipulation of the body, and treatment for real health issues. So, I think Vermonters reasonably assume that there are some minimum standards in place. And right now, that assumption would be wrong. So, why did I introduce this, Phil? Well, first, I don't think I knew it as spicy an issue as it was. It sounds like it's been debated a little bit over the years. But I really believe that this type of work requires education, training, and demonstrated skill, and background checks. Upstairs in committee corrections, we regularly hear about horrific accounts of just the reality of sex trafficking and exploitation that happens all around. It's hard to track, but certainly this is an industry where you see some illicit behavior done in some of these storefronts here. So licensure isn't a silver bullet for that, But weak or nonexistent regulation can create blind spots on that. And just to put in perspective, every other state around Vermont right now has licensure. So if there's gonna be ban actors operating, are where they going to go? I think it really does create a bit of a Wild West of Vermont without these regulations in place. So, this feels like closing loopholes. So, right now, debate is sort of licensure versus registration, which we currently have. And licensure, what it would do, lays out

[Rep. Conor Casey (Montpelier)]: the bill minimum education and training standards, defines a scope of practice, requires background checks, and would protect both the practitioners and the clients. Right now, under registration, which we have, it doesn't have that. Under registration, anyone can pretty much hang a shingle outside, register with the SOS,

[Rep. Conor Casey (Montpelier)]: call themselves a massage therapist. I think that's a dangerous thing. Massage therapists already pay licensure level fees for a system that doesn't actually protect the profession or the public. So, again, it's the Wild West. We're an unlicensed island in a sea of New England states. Registration is often defended as protecting the public, but I'm not sure that claim is well founded there. Consumers should be able to walk into a massage therapy establishment, with confidence that the person training them is a trained professional who has passed the background check. So, prevention and public safety, biggest advantage, and really what got me into this bill, was prevention. Is it going prevent all illegal activity? Of course, it won't. But bad actors are unlikely to complete education training, submit to oversight, press background checks. Licensure raises that barrier to an entry in a way that's meaningful, in a way it will reduce risks. So, obviously, lot of people are registered under OPR right now. The bill takes that into consideration, creates a legacy pathway for existing massage therapists, tries to do a better job professionalizing the profession going forward. And experience counts. There's multiple ways that the current practitioners can become licensed based on their work history, or their current training here. So, it's really not about pushing people out of the profession. It's about setting clear and reasonable standards going forward. It also licenses establishments, which is an important note, not just the individuals. And that also helps with accountability and consumer protection. You'll note, I got another bill in your wall, the Interstate Compact for massage therapists there. And that really would require this bill to pass first because you would operate in that contract. The contract allows licensed massage therapists to practice across participating states, supports professional mobility, improves data sharing among regulators, and reduces unnecessary costs. Again, of course, we can't do that unless we license massage therapists in our state there. So, in closing, brings us in line with the rest of the country. It's about public safety, professional respect, consumer confidence, and, yeah, look look forward to hearing any questions and appreciate your consideration of this bill. Yeah. No. No.

[Chair Matthew Birong]: No. Thank you. And we we brought you out on the front end of a deeper conversation with our OPR bill because we have a section that's speaking to this I feel very outnumbered. Yeah.

[Rep. Conor Casey (Montpelier)]: It sounds like a Well

[Chair Matthew Birong]: no. I mean, it is it is something that's, like, very important to address. I mean, we are very, very cautious of all the points that you've made in your testimony. So I wanted to let you know that first and foremost that we're taking a really diligent look at this right now. So

[Rep. Conor Casey (Montpelier)]: I really appreciate it, Cheap.

[Chair Matthew Birong]: Anything else for the member from the table? Rep Waters Evans.

[Rep. Chea Waters Evans (Ranking Member)]: Good morning.

[Rep. Conor Casey (Montpelier)]: Good morning.

[Rep. Chea Waters Evans (Ranking Member)]: The licensure that's required in other New England states, is that recent? Do you know any of the timelines for And have there been I was wondering if you don't know that you probably don't know the next question, is I don't know

[Rep. Conor Casey (Montpelier)]: what I don't know. Could Philip both represent

[Rep. Chea Waters Evans (Ranking Member)]: sales? If I was wondering if there was any data that supported that licensing reduced some of the more unwanted behaviors. I

[Rep. Conor Casey (Montpelier)]: think it'd be important to hear from law enforcement on that. I've spoken just anecdotally to the officers there. And it was described as just another tool they would have to bring some of this behavior to light if it's if it's happening in a way with bad actors there. But, yeah, I think it would be important to hear from them. State trooper just gave us an excellent presentation on human trafficking in Vermont there. So it might it might benefit the committee hearing from him. It's I it was a shocking presentation.

[Rep. Robert Hooper (Burlington)]: Recently?

[Rep. Conor Casey (Montpelier)]: Yep. Two weeks ago.

[Jennifer Cohen]: Okay. We can watch.

[Chair Matthew Birong]: We do have that technology.

[Rep. Chea Waters Evans (Ranking Member)]: Yeah, that's right. Just reminding everyone, myself.

[Chair Matthew Birong]: I forget sometimes

[Rep. Conor Casey (Montpelier)]: that we will.

[Chair Matthew Birong]: Repzone?

[Carrie Phillips]: When you were tracking language for

[Unidentified Committee Member]: this bill, did you look to some of those other states around us to model some language on some, just

[Lauren Hooper]: so that there's

[Rep. Conor Casey (Montpelier)]: Yeah. I think there's an there's an industry template that I received that was pretty much basis for the bill. So it it should be fairly consistent with the other states, I believe.

[Chair Matthew Birong]: Anything else from the member?

[Rep. Conor Casey (Montpelier)]: I hope everybody stays warm this weekend. It's lovely to see you all. Appreciate it. Thanks very much. We

[Jessica Chipano]: will All see you

[Chair Matthew Birong]: right. Now to the larger block of work for the morning. We have testimony on five eighty eight, which is our OPR bill. And I wanna start with, Patrick Gallivan, the executive director of the Vermont State Dental Society. He's joining us on Zoom. There he is, Patrick. How are you?

[Patrick Gallivan]: Hello. Nice to see you all.

[Chair Matthew Birong]: Nice to see you too, sir. Yeah. Yeah. Thank you for coming in. And, yeah, we just wanted to get your feedback on the section of the bill that's relevant to the, State Dental Society.

[Patrick Gallivan]: Sure. For the record, my name is Patrick Galavan. I'm the Executive Director of the Vermont State Dental Society, and thanks for the opportunity to speak to in favor of creating an academic license for dentists in the State of Vermont. With the chair's permission, I want to talk a little bit about the bill specifically, and then a bit about the new program that has been created in partnership with the University of Detroit Mercy School of Dentistry, which is kind of the reason for this part of the bill. I'm also hopeful on another date we can meet again to talk broader workforce activities that the Dental Society has been working on here in Vermont.

[Chair Matthew Birong]: Okay. And just remember, is there anybody who's tracking our page? We do have an updated 2.1, both a bill overview and a new draft of 2.1. So just to make sure everybody's working off the same document.

[Patrick Gallivan]: Great. I appreciate the work OPR is putting into this proposal. We worked with them very much on this part of the, annual OPR bill after multiple meetings and exchanges between the Office of Professional Regulation, leadership at the University of Detroit Mercy and the Vermont Dental Society, we're confident this proposal will positively impact the new dental clinic's ability to teach future dentists and a result provide greater access to care for Vermonters. Vermont is one of 10 states currently without a dental school. Every state that has a dental school has a limited license. The limited license will allow University of Detroit Mercy to better recruit faculty from outside Vermont and create opportunities for more seasoned dentists to be part of the educational process. UDM, University of Detroit Mercy has agreed with OPR's request that any dentist with a limited academic license will be supervised by a dentist with a traditional Vermont license. Why are we doing this? Well, we're in the very good fortunate place that the University of Detroit Mercy has chosen Vermont and they've reached out to the State Society in 2023 to think about dental education in Vermont. The first class after multiple conversations with the Vermont State Dental Society and local dentists, we made a decision to go into a memorandum of understanding with Detroit Mercy to stand up a dental clinic in Vermont. The first cohort of the University of Detroit Mercy began in Detroit in September. 30 students of their 160 will be spending years three and four of dental school in Vermont in a clinic that we stand up. We have rented a facility and it's in Colchester, and the facility is currently under construction. The construction will ultimately result in a 40 chair dental clinic, which will be serving Medicaid patients primarily. So we're doing two things in this clinic. We're addressing access to care and treating the most vulnerable and also working on workforce. We will have 30 students joining us in Vermont in the 2027. And obviously those 30 students will need educators to teach them in their final two years of dental school. This is a very exciting program for Vermont. I had the opportunity to go to Detroit last fall as a guest of the University of Detroit Mercy and welcome the cohort of 30. And as I said to them when I met with them, my hope is that five or six of you in each class will fall in love with the state of Vermont or fall in love with somebody in the state of Vermont so that you can choose to make your professional career in our great state. So we've been working very closely with this cohort, even as early as their first days to ingratiate them to our wonderful state. So this is really exciting project for us. So we'll have 30 students and again, next year another 30, so upwards of 60 to ultimately 64 students would be the max. We'll serve this clinic of 40 chairs and serve our most underserved body. This is really wonderful news for Vermont, wonderful news for dentistry and access to care. And I'm happy to take any questions about the limited academic license and look forward to talking to you again about workforce at another point.

[Chair Matthew Birong]: Thank you. Representative Hooper Burlington.

[Rep. Robert Hooper (Burlington)]: You, Patrick. That's great news for our community. Have you made any provisions for this is larger than I would have conceived you doing. You made any provisions for housing for the people that are going to be relocating from outside the state to inside the state to a very crowded market?

[Patrick Gallivan]: Yes, representative. Is the first question I get asked anytime I have done this presentation. So it's a good one. And I should have included in my opening remarks. Housing right now, we are actually in negotiation with St. Michael's College, which is nearby the site of the clinic, and for housing for both the third and fourth year students. So housing will be accommodated for these students in the area. It's not final yet, so that's not a quotable statement, but it's well in the works and I expect will come through before too long.

[Rep. Robert Hooper (Burlington)]: Are you speaking about dorm rooms or something a little more classic?

[Patrick Gallivan]: It looks like it'll be some type of a townhouse situation.

[Rep. Robert Hooper (Burlington)]: Very good. Thank you.

[Patrick Gallivan]: You're welcome.

[Chair Matthew Birong]: Anything else for our guests? No. Seeing no hands. Thank you very much. For the other conversation you want to have, just feel free to email my committee assistant, and we can set up a time.

[Patrick Gallivan]: I appreciate that. Thank you, chair.

[Chair Matthew Birong]: You got it.

[Patrick Gallivan]: Have a good day all.

[Chair Matthew Birong]: Thank you as well. Alright. Going down the list, if we're going in order, we have next the secretary of state's office.

[Lauren Hooper]: Sure, is it okay if, Jen and Mike come together and I'm gonna sub out?

[Chair Matthew Birong]: Please. Yes. Yes. At this point, I expect the tandem. Thank you for asking.

[Lauren Hooper]: Good morning. Thank you so much for having us. For the record, my name is Lauren Hooper. I'm the Deputy Secretary of State, and I have with me

[Jennifer Cohen]: I'm Jennifer Cohen. I'm the Director of the Office of Professional Regulation.

[Lauren Hooper]: We're so excited to testify on many aspects of this bill. And if I could just take the liberty of introducing the people that you're going to hear from, they'll introduce themselves for the record as well. But we feel very fortunate that we brought a large group of our team here today to talk to you. So I'm just going go around the room and introduce them. This is Chris Bowdich. She's the Deputy Investigator for our Enforcement Division. Emily Trudeau, she's a staff attorney with our team. Emily Carr, our General Counsel. Perry Phillips, our executive officer for pharmacy, Derek Everett, our chief inspector. So this bill touches on quite a few of the different operational parts of OPR, And we decided that it might be good for you to hear from them as opposed to just hearing from me and Jen. So you heard about dental licenses. Patrick really is the best person to speak to about that. We're very happy that he is here and that you heard directly from him. Emily Trudeau was the primary person who worked on that language. So if you have specific questions about the language, she would be available to come up and testify. But Patrick is really the best person for you to hear from. And then the next area that we have is massage establishment registration. If you folks have any questions specific to massage qualifications licensure tacking on from the previous bill, we're happy to talk about that. But if you're ready to just move to registration of massage establishments, then I will cede the chair and give it to Chris Vouch.

[Chair Matthew Birong]: Let's just park that other conversation right now and just focus on what we have referenced. Yes.

[Chris Bowdich]: Yeah, go ahead. For the record, my name is Chris Spoutisch, I'm the Deputy Chief Investor

[Rep. Robert Hooper (Burlington)]: for

[Chris Bowdich]: the Office of Professional Regulation. In that role, I conduct investigations, both in a regulatory civil aspect and also any criminal investigations, because I am a law enforcement officer. Happened for quite a few years. I previously worked for the Middlebury Police Department in Middlebury, Vermont, and actually also out in Arizona before that. So on 04/01/2021, our office began regulating massage therapists, body workers, and touch professionals. And since that time, we've received 102 complaints. 40 of those were for unauthorized practice, which there was a bit of a learning curve while people were learning that they needed to be licensed. And when we look at things that were reported that were human trafficking, we had 22 complaints specific to human trafficking, and then there were 29 complaints that were specific to sexual conduct or personal boundaries or grooming behavior that people were experiencing. That was reported to us. Of all those complaints, 19 of them resulted in discipline. So currently, we do regulate the therapists themselves. This has been very effective. We've been able to protect the public and we've been able to remove some bad actors from the ability to practice. And when we think about the reports of human trafficking, it's been a little bit less successful, which is where this idea of regulating the establishment itself has come from. A lot of times the violations that are occurring with human trafficking, the massage therapist who's engaging in that conduct is doing so out of a dynamic of force, threat, or coercion that's being acted on them by potentially the owner of the business. The only avenue we have currently regulating simply the therapists themselves is to further victimize them by charging them with unprofessional conduct. And so, OPR doesn't really want to do that. We shy away from further victimization of anyone. And so the addition of a massage establishment registration would give us the ability to hold the owner of the establishment responsible for the conduct that's happening inside the establishment, which is going to help us, it's another tool on the tool belt, to tackle human trafficking. OPR is going to have the ability to inspect the establishment, which is going to improve the abilities of investigators to observe those indicators of human trafficking. We're going to gather information about the owners of the establishments. And these owners will be held responsible for the conduct that's happening inside the establishment. Au pair will have the ability prosecute, discipline, and close these establishments. And I just want to say that human trafficking is happening. It's happening in Vermont. It's happening in all areas of Vermont, in every county in Vermont. In some of the bigger towns and cities, there's more than one establishment. It looks like human trafficking is happening there. You can see on internet websites, covert language about what services you can get there with emojis that mean certain things to certain people. And so it's happening there. We've seen it. This is what we're seeing as the best avenue to tackle the human trafficking. Human trafficking is not unique to Vermont. It's happening in every state across the country. I've attended lots of trainings about how to combat human trafficking. There's lots of conversations about what can be done. Every state is trying to come up with ways. And when we think about that tiny bit of human trafficking that's happening inside these stop massage establishments, it's very good way to tackle that. And I think I've hit all the things I wanted to talk about. Are there any questions from anyone?

[Chair Matthew Birong]: I don't think I necessarily have a question. We've had a lot of conversations in and around this, so you're just really affirming the structural application, what we've heard in testimony, both last session leading into this. So, thank you for that, And I'm glad to see we're getting to a point where we're putting proposing to put better structural safeguards in place on this one. So first and foremost, thank you. Rep Hooper of Burlington.

[Rep. Robert Hooper (Burlington)]: Is there a universal definition of term human trafficking that you're using or is it?

[Chris Bowdich]: Human trafficking is a little bit complicated in that it can mean a lot of different things. Sometimes that human trafficking is specific to

[Rep. Robert Hooper (Burlington)]: sexual What are using for the standard?

[Chris Bowdich]: I would have to get back to you about what the exact definition would be that we were using.

[Unidentified Committee Member]: Thank you for all the stuff that you're doing. I was also wondering if you thought that this would have a benefit to all massage establishments as well, because it would raise legitimacy and people would maybe have more comfort with them.

[Chris Bowdich]: Oh, absolutely. I think there's definitely legitimate massage practitioners who are witnessing what's happening at these not so legitimate locations. It's very disturbing to them, to their professionals, and they're being professional and they're offering a service. And then they're knowing that the public can't tell necessarily from the outside what's happening inside. Unknowing someone might go to one of these places looking for a massage, and that's not what they're going to receive.

[Rep. Robert Hooper (Burlington)]: Any other questions on this? No?

[Chair Matthew Birong]: Alright, no, thank you.

[Carrie Phillips]: Thank you.

[Jennifer Cohen]: So, Emily Trito just made me aware that there is a witness from the ISHTAAR Collective, and I don't know if they've communicated with the committee assistant, but that may be an organization that you want to hear from. It's an anti human trafficking organization, and they were one of the stakeholder groups that OPR had to consult with in coming up with the structure of registration for the regulation massage establishment. I do think that that person is standing by, but I don't know that they have a they have to have a link to They

[Chair Matthew Birong]: would have to have a link. Yes. I mean, we're happy to bring them in when we pick up further testimony. We were gonna talk to stakeholder groups as well. Okay. I'm just looking at the clock, and we have a vote scheduled for 11:30. Okay. On a different bill, but we will happily, happily link up for that testimony.

[Jennifer Cohen]: Okay, thank you. H588 includes three changes related to midwife licensing. And I'd like to give a little bit of testimony about that. And then we do also have here today, Katheryn Bramhall, who is a licensed midwife. And I think she's on the witness list. So if you'd like for her to I can step away. Ready. There's future Welcome to join me, if you'd like. Introduce yourself. Yes, thank you

[Katherine Bramhall]: for having me. My name is Katheryn Bramwell, a licensed midwife in the state of Vermont and New Hampshire. Been licensed since 2008 doing home births, out of hospital births technically, but at home. And am under the rules of the Vermont Secretary of State's rules for midwives. I serve on the Office of Professional Regulation's Advisory Board. I also am an owner of Gentle Landing Birth Center in Hanover, New Hampshire, which is a freestanding midwife led birth center that is regulated and licensed by the Department of Health and Human Services in Concord. And again, my rules and regulations in New Hampshire.

[Chair Matthew Birong]: Well, thank you for coming in.

[Jennifer Cohen]: You're welcome. So just to give a little bit of a framework of the changes that are proposed in H588, one change has to do with the qualification for initial midwife licensing. That qualification is a certification from the North American Registry of Midwives, known as NARM. And NARM has very rigorous standards for training, continuing education, ongoing peer reviews. It's such a signal of professional competence that the General Assembly made it the only requirement for licensure. And in our enforcement process, recently we had a case that involved an individual who had been certified by NARM at one point, but had let that certification lapse. And the resulting decision that we got from an enforcement case was essentially that we needed to make it clear in our requirements that for renewal, you had to still have that NARM certification. So that's an ongoing requirement, because it seemed like a more legalistic interpretation was that it wasn't necessarily required. So we wanted to make sure that folks continued to be certified by NARM. The other two changes would help streamline OPR's regulatory operations. In one of the changes, we have two bodies in this profession. We have a midwife advisory board, which Ms. Bramhall serves on. And then we have the midwives advisory committee. And it's somewhat duplicative because we feel like the support that our office needs and gets from our advisors is adequate for our needs, our enforcement needs, and our regulatory needs. The advisory committee has been really problematic to staff because it has physician members on it. And again, it's somewhat duplicative because the same topics that the advisors are talking about are going to be similar things that the advisory committee would be talking about. So the bill would eliminate the advisory committee and leave us with a single advisory board. And that's what we have in all of our advisor professions. We don't have other advisor professions where we have multiple duplicative committees like that. And then finally, the bill would allow OPR to revise and reduce burdensome data reporting requirements. And you'll see in our written testimony, hopefully you have that in front of you, there is a list of 20 data points that midwives have to report every licensing renewal, every two years, for every single birth that they attend. And I'm happy Ms. Bramhall is here because she could share with you what a burdensome requirement that is. So we'd like the ability to kind of reduce that burden and also to designate a different recipient of that data. Because the data that we're getting is not necessarily data that OPR is going to use. It's data that was designed initially for Vermont Department of Health. So it's not for OPR's use, and it might make more sense in the future for us to be able to designate another recipient. But Ms. Brinham, I don't know what pieces of that you wanted to speak to. Yes, thank

[Katherine Bramhall]: you very much. I'll go in order.

[Chair Matthew Birong]: Please. The

[Katherine Bramhall]: first point of conversation is about the requirement for NARM certification for renewal of a license every two years. Now, in order to become licensed initially, as I'm sure you know, as a midwife, you to be certified through the North American Registry of Midwives. There's various ways that you can actually get that certification. But all of the standards are the same, regardless of the way that you gather that experience and that knowledge. You have to recertify every four years with NARM. Every two years, you have to relicense in the state Vermont. It's not an unreasonable expectation. A lot of the things that you have to submit for NARM are similar to the licensing requirements. You have to have certain numbers of peer reviews per recertification. You have to have certain number of continuing education points, you have to also submit your what do you Practice practice data. Data. Thank you. So it's very similar. And in my opinion and in my experience, A, if you initially had to submit to your NARM certification at the beginning of your licensure, there isn't any reason not to recertify with NARM because it's almost the same application process. It's inexpensive. Some

[Rep. Conor Casey (Montpelier)]: of

[Katherine Bramhall]: the reasons why midwives won't do it are varying. One might be that they find it duplicative, a repeat thing. I highly endorse it, the requirement, actually. And I'm happy to take any questions about that, if anybody has

[Rep. Robert Hooper (Burlington)]: any. Any questions about these?

[Katherine Bramhall]: The second question is referring to the advisory committee. Does anybody have any questions? The advisory committee, number one, we're having trouble just getting in our experience through the advisory board is that we actually have a little bit of a difficult time filling the position for the physician, actually filling the position, most especially for the If there's competition between a committee and the advisory board, there's enough of us who have physician referrals access because of the amazing work that the midwives have done creating collaborative relationships in hospitals all over the state. Vermont is extraordinary in that way. And the openness between all of the small community hospitals, the larger hospital, and home birth and nurse midwives. I don't see a reason that that might I've endorsed that also. That motion. And as far as the practice data, it's a little bit more complicated, but I agree. We're up for licensure and relicensing in January. And I was just talking to my staff, and I just said, we have to start now on the data. We actually have spreadsheets, and it has to line up with the whole thing. It's cumbersome and arduous. And this isn't a question of should we collect practice data? Collecting practice data is a quality assurance, quality improvement, quality, a way to figure out where you could always be better. That's not the question. Having to check every single one of those boxes for every single birth, along with is arduous. Most of us, I can't speak for all of the practices, but what we are encouraged and what we just naturally do is we keep our data, we keep our statistics. We have to send them to NARM. A There couple of different ways that I know of. And then some people just keep them on their own. There's a lot. And in the last few years, that has changed a lot, the data collection thing. There are now apps, there are now, I'm not fancy with technical terms, but there's a lot of now different ways to actually keep that, that's much more streamlined. The data collection is arduous. And I agree that OPR I don't know how to testify about the OPR versus the Department of Health or wherever that data goes. But as a professional, I would love to see something change before our relicensing in January, because we're all starting to just think about that form.

[Chair Matthew Birong]: Any questions on that piece? I totally understand your perspective. Coming off of an analog structure, coming off an analog structure. That's a lot more time and energy to submit organized catalog warehouse. So, the ability to do it in a digital template.

[Katherine Bramhall]: Well, I mean, we're not actually using paper. There are spreadsheets that we create that we can electronically just go through. But the truth is, because midwives are only a Our rules basically say that we do healthy, full term, normal pregnancies. The vast majority of those questions for each client, quite honestly, it's a time thing as much as everything else. And it doesn't really apply to the vast majority of the things. Mean, we all electronic, most of us electronic chart. Now that's not the question. The question is, because we can only our scope of practice is normal, healthy, full term pregnant women throughout the whole course, the vast majority of those questions don't really apply to every single person.

[Rep. Robert Hooper (Burlington)]: Further? Appreciate

[Chair Matthew Birong]: taking the time. Yes.

[Jennifer Cohen]: Next, we have sections eleven and twelve in H5-eighty eight, which is the pharmacy piece of the bill. And that includes revisions to the practice of clinical pharmacy and the authority of pharmacy technicians. We have with us today our Pharmacy Executive Officer, Carrie Phillips. And she is going to walk through some of that with y'all. You can sit in whichever chair you want.

[Chair Matthew Birong]: Welcome, Carrie.

[Carrie Phillips]: Thank you.

[Derek Everett]: I like this little book here.

[Carrie Phillips]: I like when my feet touch the floor.

[Chair Matthew Birong]: Yeah, I want you to be as comfortable as possible.

[Carrie Phillips]: It's very rare. Thank you for having me. For the record, I'm Carrie Phillips. I am the Executive Officer of the Vermont Board of Pharmacy with the Secretary of State's Office of Professional Regulation. I am a licensed pharmacist. And I wanted to just kind of give you some information about this section of the OPR bill. And it touches on immunizations provided in pharmacies. And right now, being prescription drugs, when you go into a pharmacy and you want a vaccine, it can be provided by three different pathways. You have a prescription from your prescriber, or a pharmacist can prescribe a vaccine pursuant to a pharmacist prescribing protocol for a vaccine. Or the Commissioner of Health can generate a standing order, which essentially acts as a prescription for the pharmacy to use, in absence of an actual prescription from your direct prescriber. So under current law, pharmacists can prescribe and pharmacy technicians can administer to ages 18 and up vaccines that are ACIP recommended. And ACIP stands for the Advisory Committee on Immunization Practices. It's part of the CDC or central Everyone knows what CDC stands for, because right now my time isn't working. At any rate, ACIP was once the evidence based reliable authority for providing recommendations for vaccines. That has recently changed. And what we are trying to do with the changes in this section of the bill is to untether ACIP only recommendations for pharmacists prescribing and pharmacy technician administration of a variety vaccine. So earlier this year, this ACIP had changed recommendations. They completely removed recommendations for mumps rubella varicella measles, mumps rubella varicella vaccine for anyone, and had basically said that the COVID vaccine was only for 65 and up. So we were able to address some of that issue, thankfully, because there are two state protocols for pharmacists prescribing of vaccines. One is for a number of vaccines 18 and over, or over 18. And then there was a protocol for COVID and flu vaccines for ages five to 18. Statutorily, that protocol is not tied to ACIP in statute. It was in the protocol. We were able to revise that. And concurrently, the Department of Health worked very closely with them. The Commissioner of Health developed a standing order for COVID vaccines that untethered it from ACIP only recommendations, but relied on recommendations from a variety of evidence based organizations. So what we can't do until we change the statute is to untether that for vaccines for folks 18 and over. And so what this bill does is to remove the language specifying ACIP recommendations so that there is not that obstacle for pharmacists to prescribe and administer and pharmacy technicians to administer vaccines, as they have been doing now under these protocols since about 2019.

[Rep. Robert Hooper (Burlington)]: Understood.

[Chair Matthew Birong]: I think I'm gonna hold on that. That's a deeper question. Any questions for this component of the bill? No, thank you for that detail.

[Jennifer Cohen]: Thank you. And we also, I think also on your witnesses is Jessica Chefano. She is the policy director from the Vermont Department of Health. So I don't know if you would like to take her testimony now in this issue or Probably here. We have minutes.

[Chair Matthew Birong]: I'm sorry, less than 9AM. Good

[Jessica Chipano]: morning. I will be very brief. Jessica Chipano, policy director. And I just wanted to echo everything that Carrie said about the need for flexibility to be able to follow those science based and evidence based immunization schedules, not only from CDC and ASIP, but also these other international medical organizations. And it's especially important now given what we've seen to changes in federal policy, which have raised many concerns that Vermont may face gaps in vaccine coverage, disruptions in access to vaccines for both children and adults, increased costs to the state for vaccine procurement, and reduced liability protections for providers. So these particular statutory changes for pharmacists and pharmacy techs will enable these folks to continue to administer the recommended immunizations, which is a really critical tool for ensuring access to people across our state. A significant proportion of adults receive their routine immunizations through local pharmacies, especially COVID and flu vaccines. And this respiratory virus season, we've had twenty percent of children, fifty percent of adults aged 19 to 64, and fifty nine percent of adults aged 65 plus receive COVID and or flu vaccines at a pharmacy. So these changes to enable pharmacists and pharmacy techs to administer these recommended immunizations is critical for preserving access.

[Chair Matthew Birong]: I personally very much respect that approach. So thank you.

[Jennifer Cohen]: Thank you so much. And the last bit of the OPR bill in Section 13 that we have is about funeral services. So I'm going to invite our Chief Inspector, Derek Everett, to come sit with me. Five eighty eight updates the definition of funeral services to include some newer disposition methods. And Derek can talk with us a little bit about that. Just introduce

[Derek Everett]: Hi, everyone. Derek Everett.

[Derek Everett]: I run the inspections unit at OPR. We're under the umbrella of the licensing division. And this is a real quick one, just a language cleanup. Traditionally, the practice of funeral services are provided to funeral directors, which gave them the complete kit in that industry to do anything within the industry, with the exception of embalming, which is a separate credential. In 2022, we moved from just having traditional burial and cremation to also offering alkaline hydrolysis and organic reduction. And we created a disposition facility license, which kind of covers everything other than traditional burials. So you have organic reduction, alkaline hydrolysis and cremation. Unfortunately, the way the statutes previous to 2022 were set up is just dealing with cremation. So we kind of open that up to the newer forms of disposition. And we missed a little piece where the practice of funeral services didn't include that. So it's a little bit of confusion, but a licensed funeral director can pretty much do anything but embalming. Most funeral directors do have embalming licenses, but there was some confusion with who can manage at this specific facility, who has to have that certain credential to be in there. So this just kind of cleans it up and puts everything back into the purview of a funeral director. That's pretty much it.

[Rep. Robert Hooper (Burlington)]: Okay. Very complicated.

[Chair Matthew Birong]: Yeah, myself and representative Hango spent several, bienniums on the general committee, so we were familiar with this stuff when it's inception, so it's, know, seeing it now within this phase, right? It's the process processing and the stuff getting implemented. So yeah, touching on it to make it more current.

[Jennifer Cohen]: And we've been seeing, I think we've got a couple of facilities that offer alkaline hydrolysis now in Vermont.

[Chair Matthew Birong]: We have two.

[Jennifer Cohen]: Yeah, two. And so it's coming, these other methods, but good that we're cleaning up the laws so that people are clear requirements are when they're opening those new facilities.

[Chair Matthew Birong]: We love that vital, but yet not glissy work here. So, any questions for the director on that piece?

[Jennifer Cohen]: And that's the last piece. So any other questions?

[Rep. Conor Casey (Montpelier)]: Look at us.

[Jennifer Cohen]: Don't want to open up too broad.

[Chair Matthew Birong]: No, no, no. But hey, we got clock.

[Jennifer Cohen]: But we talked about today. Yeah, let's not you don't have to run off the clock.

[Chair Matthew Birong]: No, no, no, we do not. Rebecca? Yeah,

[Chris Bowdich]: I have a really quick

[Unidentified Committee Member]: question, I'd say, for Ms. Phillips about I think it's for her About pharmacy. Immunizations at pharmacies. If you get your immunization at a pharmacy, you can pretty much walk in, make your own appointment, and at your own will, get an immunization. How is that communicated to one's primary care provider and or the state registry for vaccinations? Because I understand there is one. And the reason I'm asking this is an individual known to myself, being me, got a second immunization when only one is supposed to be given. And that was my own fault because I scheduled it on my own. And I am just really curious at how the pharmacy would have better responded and said, wait, you already got that last year.

[Carrie Phillips]: You don't ever need another one again. So, Carrie Phillips again. Thank you. Pharmacists, just like every other health care provider that provides immunizations are required under Title 18, I don't recall the section, I'm sorry, to report all vaccines and vaccinations into the Vermont Immunization Registry. That is a requirement. And if it's there, they will find it there to prevent exactly what we're talking about, or prevent, say, a prescriber or doctor administering the sanitization. That is a requirement. If that doesn't happen, just like all of our 50 plus professions, if there is an instance where there is a concern about a professional not following a requirement, and certainly when that leads to an issue that can't be the age of the public, we have a very wonderful, robust complaint process, and you should absolutely submit a complaint, because we can't fix what we don't know about. But that is an expectation.

[Unidentified Committee Member]: Sorry that that happened. It's fine. It's fine. It's on me, because I didn't keep my own records. So there should be a reporting requirement and a cross check. Has this individual ever absolutely. Gotten this vaccine?

[Carrie Phillips]: Part of the report with the expected required process.

[Unidentified Committee Member]: And nothing will change now that we're not following the CDC

[Carrie Phillips]: No, the requirement, as you said, is in Title 18 and completely separate from any of these other statutes.

[Unidentified Committee Member]: And the requirement won't change that if it's a once only in your lifetime, that won't change anything under these changes? Not at all. Okay, great. Thank you.

[Chair Matthew Birong]: Clarification. Anything

[Rep. Conor Casey (Montpelier)]: else from the table? No.

[Jennifer Cohen]: Thank you so much.

[Chair Matthew Birong]: Thank you so much.

[Jennifer Cohen]: We appreciate it. We'll call

[Chair Matthew Birong]: a five minute time out, so we pick up the ESX charter for discussion and book. Please take us off.