Vermont Legislature SmartTranscripts:

[Speaker 0]: Okay, welcome back, folks. We are now picking up version 3.1 of H545, a bill on an act relating to issuing immunization recommendations. So, Katie, as you recall, committee, we made several changes yesterday. We looked at language that incorporated the sunsetting of certain provisions of the bill to revert back to what we have now. Just as a reminder to people, what that means is that whoever's sitting in these seats six years from now is going to have to be looking at this, and whoever is sitting in the health department seats at that time will also be looking at it. So thank you, Katie. If you could take us through and just reminding people that things that were in yellow yesterday are not in yellow now, because they've already been reviewed.

[Speaker 1]: Thank you. Katie McLean, Office of Legislative Counsel. So we have new yellow today. This is draft 3.1. So we have our section one, which is the immunization funding. I don't believe there are changes to this section. Nope. Oh, we did. So for the financial advisory group, there is consistent language that the committee shall receive administrative and technical support from the department. Antechnical was at the top of page five. Thank you. Top of page five. Section two, this is the recommended immunizations. This is the language that completely goes away in 2031. There were some changes here. So if you remember in subsection D, I said that there was a typo because scope was referenced twice, that's been corrected. Or administering recommended immunizations is within the scope of the health care professional's practice. Then we have the advisory council. So we had some changes to the membership. Subdivision one mirrors subdivisions two and three by saying that the executive director of the Vermont Board of Medical Practice or designee. Subdivision six, you asked to move the rep for public schools closer to the Secretary of Education, so that has been moved up in the list. The health department reached out and asked the epidemiologist to be capitalized. I think it's a title state epidemiologist, so that's why that is capitalized. Similarly, in subdivision 10, the health department pointed out a typo, so we've added the word of or any combination of these individuals. There had been a section nine that used health care professionals as defined, that language or that item you have removed from this list. And instead on page nine, you've added practicing advanced practice registered nurse licensed pursuant to 26 VSA chapter 28 appointed by the governor. And a practicing pharmacist licensed pursuant to 26 VSA chapter 36 appointed by the governor. And then we're renumbered Just

[Speaker 0]: I'm sorry, Kate. Those were changes that were recommended by the Office of Professional Regulation, just to remind people of

[Speaker 1]: that. And then we renumbered the last item. Subsection C, there was a request for language that the Secretary of Education and the representative of public schools not vote on matters related to the recommended immunizations. So I've restructured this subsection C. That's what the changes are in lines eight, nine and eleven. And I've added a new subdivision that the Secretary of Education or designee and representative of public schools shall not vote on advice regarding recommended immunizations as defined in Section eleven thirty of this title.

[Speaker 2]: Quick, quick question.

[Speaker 0]: Go for it, Representative Donahue.

[Speaker 2]: So I'm not flipping back to it in front of me, but did we change recommended immunizations to recommend the definition so we don't have a definition of recommended immunizations anymore? So

[Speaker 1]: I think you're referring to the conversation we had with regard to what happens on 2031.

[Speaker 2]: All right. Skip the question. Thanks.

[Speaker 1]: Okay. We will get to that. In 2031, we go back to immunizations. Thanks.

[Speaker 3]: Chair?

[Speaker 0]: Yes. I'm sorry. Go ahead.

[Speaker 4]: I just want to ensure that I've got clarification in my own head about the role of the secretary of education and the representative of the public school is that we are envisioning them as being part of the conversation, if you will, lending some context to how this may play out in education setting, but ultimately not being voting members because they lack the medical background. Is that how we envision it?

[Speaker 0]: Not exactly. This advisory group serves more than one purpose. So the purpose that we're discussing here is for recommended immunizations. And so yes, they would be non voting members because they're not medical professionals. It'd be like me sitting on a, having an opinion. I'd have an opinion, but it's not based

[Speaker 1]: on anything except for my own opinion.

[Speaker 0]: So, however, this group also makes recommendations with regard to immunizations in another part of the bill regard to entrance into public school facilities for which they would be a voting member. Okay.

[Speaker 1]: Thanks for the clarification. I'm sure you're not looking for changes at this point, but if you want to capture that, you could say something like shall not participate in discussion or vote on advice regarding recommended immunizations. Or you could just leave it as

[Speaker 0]: it is. We'll just leave it as it is. Think it's good. If

[Speaker 5]: you try.

[Speaker 1]: Okay. So no changes to assistance or the meetings. This next section next two sections are our insurance coverage. I don't think there are any changes here. And then the two following sections. So to follow along, I'm at the bottom of page 11, top of page 12. The next two sections have to do with the pharmacist and the pharmacy technician. There was a change in this section six, and that is to refer back to recommended immunizations as defined in '18 BSA eleven thirty for patients 18 years of age or older.

[Speaker 0]: I might be confusing myself. I'll allow what Anne's question was.

[Speaker 1]: Help me understand why that's not eleven thirty a. Because the definition itself is in eleven thirty. It's the first page of the bill. Okay.

[Speaker 4]: If you scroll to the top of page 13, maybe that's where you're you'll see reference to eleven thirty a.

[Speaker 1]: So let me walk you through the distinction on those two subdivisions. So for patients 18 years or older, the authorization is for any recommended immunization. So that's why we're referring to the definition and eleven thirty of recommended immunization. Will you say that again? In this Roman numeral seven, we're talking about any recommended immunization for patients 18 years or older. So we're referring to the exact definition of recommended immunization because we're not parsing out one piece of the schedule versus another. We're referring to the whole package of recommendations. In Roman numeral VIII, we're identifying for patients five years or older certain immunizations. We're not referring to the whole package of recommendations that are being made. So instead of referring to the definition that encompasses that whole package, we're referring instead to be consistent with recommendations established in accordance with eleven thirty a, meaning the administration is consistent with the process that was set forth, but not adopting the whole schedule. Does that make sense? I get it now. Thank you. You're welcome. It is confusing. Section Okay. Seven. I don't think we had a change here. Nope. Okay. So that brings us to PagerMAN. We are on 14. We're in the middle of the page, line 15, and now we're restoring the current immunization recommendations on 07/01/2031 to a version of what they currently look like. This is where I think representative Donahue's question was about retaining immunizations. So you decided yesterday that while you're going back to the current language, there's some of the changes that are being adopted in this bill that you want to retain. One of those changes is using the term immunizations, and this qualifier means a vaccine or other immunizing agent that provides protection against a particular disease or pathogen, fourteen and fifteen. And so that language takes effect on passage and this highlighted language is no longer crossed out. That means you're keeping it. You're keeping it moving forward. And then a lot of the highlighting in this section of the word immunizations is because it was struck through previously. The current language has the word vaccines. You've chosen to use the word immunizations to be broader for the definition. And so you're seeing that you're retaining the word immunization from your changes that are taking effect on passage.

[Speaker 4]: Question? Go ahead. On page 14, line 15, I forget how you refer

[Speaker 0]: to those headers or Yeah, reader's assistance.

[Speaker 4]: Do those appear in statute or is that just for us in this process?

[Speaker 6]: That's just for this process.

[Speaker 1]: It will be in the final act.

[Speaker 4]: I'm wondering if that's technically correct when it says restoring current immunization recommendations. I don't know that we are restoring recommendations as of this date. We're really referring to the process. We're reverting back to basically following the federal, which may change in six years. The federal CDC guidelines would change. See the distinction I'm making?

[Speaker 0]: Use of the word current is probably should I say certain? We're not doing

[Speaker 1]: I was thinking that's where you were going, but now we're kind of taking some, but not everything. Yeah.

[Speaker 2]: Is it right? Restoring current immunization processes or program processes? Cause it's the immunization program of the state

[Speaker 4]: purchasing I

[Speaker 0]: and so

[Speaker 1]: want to say something to indicate that it's not everything. Restoring certain

[Speaker 0]: the only way I Certain do though.

[Speaker 1]: Certain current immunization processes. I

[Speaker 0]: don't honestly like the use of the word current, because it's time sensitive. Yeah, it's meant

[Speaker 1]: to help the reader right now understand the bills they're reading it. It won't go into the green books, but it would be in the acts and resolves, which is the white books over there. So

[Speaker 2]: restoring because it's the date of the act, it seems like restoring would communicate that without the word current.

[Speaker 1]: Okay, that's what I was going

[Speaker 6]: to say, like restoring certain immunization recommendations on July 1.

[Speaker 0]: Right.

[Speaker 1]: Okay, I think we processes instead of recommendations. Yeah. Yeah. Wanna make sure I come back with the right words. Okay. I can make that change. Okay. We're still on page 15, subdivision B1. Here you'll see several places where immunizations is highlighted. It previously was struck through, like recommended immunizations was struck through and replaced with vaccines. So now we're just striking through recommended and you're retaining immunizations to reflect the definition up above.

[Speaker 6]: Let's see, page 16. Do you have a question, Representative?

[Speaker 5]: No, I'm just, I mean, the only way I can think of this is that we're sort of both making technical changes to a current bill and then we're also making bill and we're going back to the technically change is the way I'm thinking of it where as if we're presuming that the technical changes will

[Speaker 2]: To the statute, not

[Speaker 0]: the bill.

[Speaker 5]: Yeah. To the statute. Yeah.

[Speaker 0]: Right. Right. To the existing statute. Right.

[Speaker 4]: It's like we're doing two things

[Speaker 5]: at once. Six things, really, but no. Don't confuse me.

[Speaker 1]: On the top of page 16, subdivision B3, it had said preventable by vaccine. Now you're retaining immunization. Same thing in subsection C. You're using the word immunizations. In this sentence that's being underlined, It was the same thing. That was a sentence that's in current law. It is removed as drafted, and now it's being added back in. I've had to use the word vaccines, now it's using the word immunization. Same thing in D, same thing in E, G. Oh, this is exciting, though. Yeah. 17. Line seven, you have ellipses now. So we're not showing the membership of the funding advisory committee. That means you're keeping the changes that you're making in section one of the bill. So you've shortened your bill by two pages. Wow.

[Speaker 4]: And

[Speaker 1]: then let's see. Then you have subdivision G3 with the same change, keeping immunization. Same thing in subsection H. We're on page 18, section nine. We are doing the same thing on line nine with the ellipses that are highlighted. That is omitting subsection B. That means that you're not making a change to the language in subsection B as you're amending it on passage. You're just keeping it as is. This duty section has revert back to the way it currently is because you right now have this language referring to the recommended immunizations. You have language about the secretary and the public school representative not voting. So what this change does is it reverts back to what the current language is. Okay.

[Speaker 0]: So now I'm confused a little bit. Okay. Because this does not this does not appear in the first part of the bill.

[Speaker 1]: It does. Yeah, it does. Oh, alright. I'm confused. It is confusing. Look at page nine of your bill. Okay.

[Speaker 3]: Okay.

[Speaker 0]: So you just say again what this So is

[Speaker 1]: on page nine, this is language that's taking effect on passage, and we are reorganizing this subsection c to include subdivision c two, which is the language that the secretary and the public school reps don't vote. As of 2031, we will no longer have recommended immunizations as a term. So we're reverting this section back to how it appears in current law. And that's the change that's happening on page 18.

[Speaker 0]: Okay, so we're essentially taking out the piece where we said that they didn't be voting on it. But why

[Speaker 2]: Because nobody's voting on that. Because they're not gonna, the advisory council as a whole will not be voting on recommended immunizations.

[Speaker 1]: Charge, if you look on Charge changes. Yeah, okay.

[Speaker 0]: You getting that, Zon? Sure.

[Speaker 5]: Yes, I think I do.

[Speaker 0]: For some reason I'm picking out Zon's because he's recording with Bill, so just want to keep a nice I thought you were just picking one. No, no, no. I'm going to think about it in my head for a minute, so I don't need to take up any time.

[Speaker 1]: We have another set of ellipses on line 20 that is taking the place of subsection D. Subsection d is the language about the council having the administrative and technical support. You're not making any changes to the new language that you're adopting on passage. And so I just use the ellipses, so it's there's no change. We're just maintaining what's happening on passage. Subsection E.

[Speaker 5]: Sorry, one question here.

[Speaker 0]: Yeah, go ahead. So

[Speaker 5]: if I understand correctly, I see above line nine and line 20 have yellow ellipses. Yes. And line 10 through 19 are they're considering it right now because we're considering because it's yellow. But if you say yes to this, then that will go away and become part of these ellipses.

[Speaker 4]: Is that correct in the next version?

[Speaker 1]: No. Let me try again.

[Speaker 7]: It is

[Speaker 1]: very confusing. So we are amending this same section in section three of the bill, and all of those changes take effect on passage.

[Speaker 4]: Yes.

[Speaker 1]: Some of those changes you want to keep moving forward in 2031. Some of them you want to revert back to the way we are currently in law. So by having the ellipses on lines nine and twenty, you are making a decision that with regards to those sections that are omitted, that you are retaining the changes that you are making upon passage. Those will not be amended again. However, this subsection C that you are changing on passage would no longer make sense in 2031 because you are no longer going to have recommended immunizations. So this reverts it back to what is in current law.

[Speaker 4]: Okay. Think I got it. Thank you.

[Speaker 1]: Yeah. You're welcome. I know. There's mud. Let's see. Page 19. You didn't have any changes from the last time you looked at this. I'm gonna pause on this line six, which is the reader's assistance, because I hear that the word current isn't the word that you're wanting to use. So would you like to say, well, is. Well, it's restoring insurance coverage. So we could just omit current there, if that's what the committee would like to do.

[Speaker 4]: I think it implies if you simply mean current, it implies that the change you made, we move insurance coverage. It simply says restoring the insurance coverage.

[Speaker 0]: Yeah. Makes it sound like there was no insurance. It's not

[Speaker 4]: all insurance.

[Speaker 1]: Yep. I hear that.

[Speaker 8]: Yeah. So that one should

[Speaker 2]: be current because that's not time you know?

[Speaker 4]: Alright.

[Speaker 0]: Is there a problem with saying restoring insurance and it's not just in this area, that other area too. Restoring insurance coverage for immunizations that and we referenced the previous date? We could, but

[Speaker 1]: then we'll have two dates. I just don't know if that would be confusing. So we're storing insurance coverage for immunizations in effect as of today on 07/01/2023. Will that make it more confusing for folks?

[Speaker 4]: Or existing upon passage rather than current? No,

[Speaker 0]: this isn't the upon passage part. No.

[Speaker 1]: Prior to passage. Restoring insurance coverage for immunizations prior to passage.

[Speaker 2]: In effect prior to passage.

[Speaker 4]: I guess I like the use of current because as our colleagues are reviewing this, they're doing it today. It's current. And if these reader assistants go away from the Green Book, there won't be confusion going forward when someone's reading the statute on what current meant, what was that date. And this is current refers to the 2026 session. Whenever we get the best.

[Speaker 9]: Suggestion was made ASAP recommended, like because we're reverting back to at that time.

[Speaker 4]: That would help with the prior one but not with this usage of current.

[Speaker 1]: Right. Because this is not

[Speaker 0]: So since some people like current, some people don't like current. Katie, just While we all know what this means today, if you were to ask us six months from now, you're going to get 11 different answers. I'm just trying to

[Speaker 1]: Can we do both restoring current insurance coverage for immunizations in effect prior to passage on 07/01/2031?

[Speaker 7]: That works.

[Speaker 4]: Does that imply the passage was on 07/01/2031? That sounded like passage was what I heard in 2031.

[Speaker 1]: Okay. Another way to do this would be to change them all and

[Speaker 6]: start off

[Speaker 1]: the reader heading with the date and then a colon and then saying what the phrase is. In other words, it comes first. On July '31. Restores. Yeah. And then for the passage ones, it would say onpassage colon, and then it

[Speaker 0]: would say what it is. I like that idea. Okay. Okay.

[Speaker 1]: So we have our our two insurance sections, and those are going back to what they are now. Those are easy. Top of page 21, these are the pharmacists and the pharmacy technician. And here we have language where they're going back to the way they appear in current law. Yep. That one's easy. And then we have the same thing here with no changes. The only reason it's highlighted sorry, here is because you made changes in the earlier section. So now the changes have to be reflected here so they can be struck through. And then we made it to the last page, page 24. So you have your appeal and you have the effective dates.

[Speaker 0]: Okay, so so people are clear about the process, next version that we see in this will be the version that we will be voting on. Okay? So if you have any questions, now's the time to get them answered because we're gonna be voting on this tomorrow.

[Speaker 4]: If I recall what we just discussed, the only changes you're going to see are on the reader's list.

[Speaker 0]: Yeah. Yes. It's about your systems. Yeah. Right. But I'm just saying if people have any questions about understanding what the bill does, what the timelines are, any of that kind of stuff, now is the time to ask them. And of course, Zon, you and Katie will be Any sort of in-depth questions that you have is definitely always very helpful. Yes, go ahead. I might not be here when you vote on it, but I do want to vote yes. Okay. If I'm not here, how do I do that? Do you know what time you'd be back to complete? I do not know. The plan? I mean, I could be here, but Tomorrow didn't know the rules.

[Speaker 1]: I don't know the rules.

[Speaker 0]: Well, we are not supposed to hold open a vote. We were told that by the Okay. But I'm just trying to accommodate you since you want to vote on the bill. I would like to, but if I can, I can't? So we have house floor at 09:30 tomorrow. I'm just wondering, I'm just making a suggestion. Give me an idea. It be here. Well, probably is going to be like I don't know, by the time everybody gets back in here, it'd be 10:30 probably. Probably about the time that you're going to be I don't know. I wish I

[Speaker 7]: joined by Zoom.

[Speaker 0]: I'm going to be in the building. Maybe I could text you say Run up quick. Exactly. I'll watch. Will text you. We'll do it that way if I'm not here. Okay. Okay. I know at eleven I can't be here. At 10:30,

[Speaker 1]: I might.

[Speaker 0]: Okay. Thank you. All right. Okay, that was the only question? All right, thank you so much, Katie, for all your work on this. Yeah, you say no problem. I know that. I know that that's not accurate. Especially when we went to the revert back part. Maybe less of a problem before we did that. Okay. Folks, we have witnesses waiting. Chris was here. He's probably outside. Yeah, Chris, come on in. Thank you for being patient with us. Okay,

[Speaker 6]: feel free to have a

[Speaker 0]: seat right in this chair.

[Speaker 2]: And I do have to bow out now, but I will review the tapes for the testimony this morning.

[Speaker 0]: Okay. It's good to see you, Anne.

[Speaker 4]: Take care, Anne.

[Speaker 5]: Thank you, guys.

[Speaker 0]: Thank you, Carlos.

[Speaker 3]: Good morning.

[Speaker 0]: Good morning, Chris. We're just gonna take a brief moment to do introductions. Sure. It's not often that we have a beach friends person in the House Human Services Committee. So you know me, but I'm Theresa Wood. I'm from Waterbury. I also serve Bolton Buells Gore in Huntington. Hi, Chris. I'm Rey Garofano.

[Speaker 9]: I live in Essex, and I also serve Essex Junction.

[Speaker 6]: Hi, I am Jubilee McGill, I represent Bridport, Middlebury, New Aid, and Highbridge.

[Speaker 7]: Hi there, Esme Cole, representing Park Group.

[Speaker 5]: My name is Zon Eastes. I live in Guildford and also represent

[Speaker 4]: Dunne. Doug Bishop, I'm a representative from Colchester.

[Speaker 0]: I was gonna say representative Steady Brenda Steady, Eastmountain Westford, and I'm also on the select board in Belvedere.

[Speaker 3]: Oh, good, Mike. Hi.

[Speaker 4]: Good morning. Eric Maguire, representative of Brooklyn City. Good morning. Dan Noyes, representative Wilkin, High Park, Johnson, Belvidere.

[Speaker 7]: Great. And then Sam, we're gonna go right around the outside. Hi.

[Speaker 5]: I'm Sam. I'm with Action.

[Speaker 0]: Hi. I'm Beverly Belgett with the Vermont Early Childhood Advocacy Alliance.

[Speaker 6]: I'm Kristina McLaughlin, I'll be happy with HGG.

[Speaker 0]: I'm Alex Brandless of East, taking moves away.

[Speaker 3]: Jed Simons, the Housing Homelessness Alliance of Vermont.

[Speaker 7]: There's Laurie. Very much so many assistant.

[Speaker 0]: Thank you, Chris. Welcome to House Human Services. Thanks.

[Speaker 3]: It's my pleasure. For the record, I'm Christopher Herrick. I'm the director of emergency management and safety for the Agency of Transportation. And you're probably saying, so why are you here to talk about homeless encampments?

[Speaker 0]: I think give people a little bit of an idea because we understand that the secretary had some mention of this issue in his opening remarks to the Transportation Committee.

[Speaker 3]: I saw that he mentioned my name, so I got my suit on a

[Speaker 1]: mothball. I

[Speaker 3]: knew I'd be here. So the state, a while back before, I started with the agency in December '20, I'm sorry, '24. So I've been there about a year, but I've been with the state for, goodness, since 1995. I was 12 when I started. I actually used to work with the chair back in the day. I do have some human services background. I worked at Howard Community Services for eight or so years. But the agent the state actually, as an enterprise, developed a policy regarding homeless encampments on state property. I'm only gonna focus on as it relates to the state right of way owned by the agency of transportation. So roadways specifically, park and rides, rest areas, rail, and even aviation. And so it's an extensive policy, and I'll only refer to it. I'm not going to get into depth. And I'll talk a lot about what Did you send us

[Speaker 0]: a copy of that, Chris?

[Speaker 3]: I can after if you haven't yet.

[Speaker 6]: That would

[Speaker 0]: be great. That would be helpful for us to understand the amount of thought and process that VTrans has gone through in terms

[Speaker 3]: of Well, and I want be clear, Madam Chair, it wasn't just VTrans or Agency of Transportation that built it. It involved other state agencies. But I think it's fair to say, without any data to support this, that we probably are interacting more than any other state agency. And as I get it, it'll probably become clear why it has more to do with where people are able to access. I'm gonna start. I just wanna read, from the purpose section of the policy. And it says, as the primary entity responsible for the development, management, maintenance and operations of transportation facilities on state held rights of way, it is the responsibility of the agency of transportation to address encampments on right of way that do not align with the intended transportation related purposes of these lands. So what is that saying? As you know, lot of and if you look at the statutes and when I send you the policy, it cites a lot of the statutes that we derive whatever we do here. We want to make sure that the roadways and all the other right of ways are being used as intended for safety purposes and for environmental purposes. So I know that all sounds very maybe cold, but as I can tell you, as I go through some maybe real life examples, I can say with surety, and you should feel comfortable that when we interact with folks at any of these locations, it's done with professionalism and dignity. And I think that's important. And as the coordinator of this program, that is my directive to anybody involved. Currently, it's mostly me and one other person from the agency who go out and do an assessment. So let me talk about the process a little bit. Have our districts and the districts will make us aware that there is an encampment on state right of way. Or I just happen to see it because I know where they tend to pop up. So I live in Grand Isle by the way. And so some of the areas that have become frequented, I go by every day. So I swing in and see what's going on. So then we'll do an assessment. And the assessment is really looking at to help us prioritize which ones we need to start working with first, because we have limited resources. And currently, since for the year 2025, we encountered and addressed 32 different homeless encampments on the state right away. And while that may not seem like a lot, each one requires a fair amount of coordination. We work very closely with the agency of human services, Renee Weeks, and I, but also we work with local agencies like the Howard Center. So I'll give you an example of one of the most challenging encampments that we dealt with. It was-

[Speaker 0]: I'm sorry, Chris. I apologize for needing to interrupt us for a moment here. Sure. And my apologies that our morning session has sort of run amok of our schedule. We have a nurse who has a very specific timeframe that she can only meet with us with. Would you mind if we interrupted just for a moment and then had you come back and enable the nurse?

[Speaker 3]: I am here for your convenience.

[Speaker 0]: She's online. You can still look at where you are. Kristen, thank you for being here. And appreciate that and appreciate I just wanna make sure that we have the right We have your name as Kristen Bond Watts. Is that the right name to have on our agenda?

[Speaker 8]: Yes, that's right. My Zoom name just hasn't changed.

[Speaker 0]: Okay, okay. I just wanted to make sure. So thank you for being here. I appreciate that you have a schedule and you've got patients to see and all of that kind of thing. So we are interested in the impact that people who experience homelessness are having on emergency services from your perspective and appreciate you being here.

[Speaker 8]: Thank you. Yeah, good morning. Hi, you guys can hear me okay?

[Speaker 0]: Yes. Okay,

[Speaker 8]: great. So yes, my name is Kristen and I'm a nurse at Porter Medical Center emergency room, is in Middlebury, Vermont. So it's considered a critical access hospital. We have a 12 bed ER. So yeah, I'm just gonna read what I wrote here. So budget cuts to cold weather shelters are pushing on housed individuals into our emergency department. I'm sorry, I have a cold too. Not because they need emergency medical care, but because they have nowhere else to go. It may appear that the state is saving money by making these cuts. However, the cost of utilizing emergency departments as shelter without an acute medical need costs us all Medicare and Medicaid dollars, but also high stakes resources that are being utilized for non medical situations, which takes those resources away from individuals that are having medical emergencies. What we've been seeing, we've had people arrive late at night asking to sleep in our waiting room to escape frigid temperatures. We've had someone call an ambulance to request a ride to a shelter two hours away that two eleven had found. And these aren't isolated incidents, they're like becoming routine. And it doesn't feel right to us to turn someone away who has nowhere to go, but our emergency room waiting room isn't designed to be a shelter. People waiting there are exposed to contagious illnesses. Families are there during some of the most difficult moments of their lives. Recently, we had a patient spend three days in our single psychiatry equipped room only to reveal that their suicidal thoughts would resolve if someone could fix their broken pipes at home. Our nurses spend hours trying to connect them with resources and this is out of our realm of expertise and it feels like the ER is not the right place to be helping people with these types of situations. We feel like we need increased funding for cold weather shelters and critically also transportation to get people to those shelters, especially in rural areas. Right now we struggle to get discharged patients a ride home just three miles away. More robust resources to help individuals who may have a home but cannot afford to maintain it, easier ways to access help when it's needed. Emergency rooms exist to save lives in medical crisis when they become a major safety net for basic human needs like warmth and shelter, everyone suffers, the unhoused individuals who deserve better, the patients in true medical emergencies who need our full attention. So thank you for your time and consideration. And if you have any questions, feel free to, I'll Thank try to answer

[Speaker 9]: you so much, Kristen. First, before I forget, can you email Lori your remarks so we can post them on our website? The thing that you read, it would be really helpful if you can send that in to us and we can post them on our website as your testimony.

[Speaker 8]: Yes, someone sends me the email address, I can do that.

[Speaker 9]: It's Laurie Morris. She coordinated your Okay, so we'll make sure. Yeah, we'll get it to you. No problem. Question, Representative McGill.

[Speaker 0]: Yeah, thank

[Speaker 6]: you. Hi, Kristen. I was born in Middlebury and grew up in Middlebury and I now live in Bridgeport with children. So I've spent a lot of time in the Middlebury The Porter ER over the years, and I appreciate the good work you do. You touched on this a little bit, but can you talk, this is something I have just been hearing in my conversations with community and state partners, is this concept of the moral injury that providers are experiencing. And you talked about it. It's like when it's freezing outside and you know that you have to turn this person away and you know there's no option. So I'm just wondering if you could expound on that a little bit and talk about

[Speaker 1]: the

[Speaker 6]: actual experience for the staff in the ER and what that feels like and how that affects you personally in your mental health.

[Speaker 8]: Yeah. I would say we've had multiple situations, particularly seems to happen late at night. I work a mid shift, so I'm usually there until about like 11PM. So in the evening, it seems that like people come in sometimes and they'll say like, oh, the two eleven told me to just come spend the night in the waiting room or like stuff that I'm like, really? I I don't know if that's true, but And then sometimes we're like, if we have a low census, we're like, well, what do we do? Should we just let this person sleep in the hallway waiting room area? But when it comes down to it and we ask the administration on call or the house supervisor, it's very clear that they really don't want that happening because it opens the door for this kind of thing to happen more and more and more. And that really does impact our ability to provide care for other patients that are in need. So to be the person or a person that has to say like, Sorry, we can't help you. Good luck out there. And then I leave my shift and I see someone hunkered down on the corner of the road. I'm like, well, that really sucks. It does put people on a difficult position and oh, my dog. Hello. And it also, yeah, there can be disagreement between like nurses, doctors. Sometimes like a doctor will be like, Oh, well let's just put them up in a room or something. Because they just really have a hard time saying no. But then other people are like, Well, only have six rooms with a door, like people are having flu and COVID, you know, all this stuff. That is a difficult situation for sure.

[Speaker 9]: Thank you, Christian. I have a question. Can you talk a little bit about interactions with law enforcement and any additional security resources that have been needed that the hospitals had to kind

[Speaker 0]: of undertake or new policies that you've had

[Speaker 9]: to put in place as a result of these increases?

[Speaker 8]: Yeah. We have implemented two security officers at all times, which we used to just have one. We used to have two on during the day and one on overnight. But with recent both, a lot of increase in mental health issues that we've been seeing, which is another issue that can also go hand in hand with this issue. I think that's the main thing that has been implemented for us. We do try to work with local law enforcement as well, but I'm not aware of any like policy changes in regard to working with them recently.

[Speaker 9]: Thank you. Representative Cole.

[Speaker 0]: Thank you. And thank you

[Speaker 7]: so much for your service, Kristen. Did you say Kirsten or Kristen? I know it's Kristen on your team, but

[Speaker 8]: Kristen. Yeah, it's Kristen.

[Speaker 7]: Okay, Thank you. So obviously a lot of changes have been happening back and forth between the legislature governor in terms of the GA program in particular on a policy level. And I am curious, I know it might be hard to monitor and track all these changes as they happen with the rules and how the rules are implemented. But one big thing that might've been notable was this past July in the beginning, 800 people were expected, including children, to be evicted from the GA program. And so I'm curious, there's one example too. Did that have any correlation to what you were seeing in the hospital? I know it's summer, so it's different. The things people are experiencing are different when they're living outside. But that could be one example. Also if anything in policy has affected even a down count in the number of folks, like for the better that you are seeing in the ER, even though I know those numbers are steadily rising overall.

[Speaker 8]: Yeah. And that's one thing that we've talked about too, just like how to better track these situations, like putting on a chief complaint, like, unhoused or something like that. That way we can look back and, like, track the numbers a little bit better for our department specifically. But, I feel like definitely when it starts to get cold, there's there's an increase. But it does feel like just over the last maybe six months to even a little bit longer than that possibly. We've had more people coming in due to, you know, situations in their own homes where they aren't able to have heat or water, or they can't find shelter anywhere. Yeah, that's but I'm not sure specifically. Yes. It's been

[Speaker 7]: really increasing. Thank you.

[Speaker 9]: Any other questions? Kristen, thank you so much for taking And the again, thank you for your service.

[Speaker 8]: Thank you for having

[Speaker 9]: Really appreciate it. Chris, if you don't mind, we have two other Zoom participants

[Speaker 0]: that we're going go to them.

[Speaker 9]: Does that work for you?

[Speaker 3]: Yeah, but I'm not gonna

[Speaker 7]: You don't want be as ahead of each other.

[Speaker 5]: I'll come

[Speaker 3]: back in a few minutes.

[Speaker 9]: Thank you. Doctor. Villa, am I pronouncing your name accurately, correctly?

[Speaker 10]: Good morning. Yeah, it's Doctor. Veith and Julie is absolutely fine.

[Speaker 9]: Right, thank you so much. The floor is yours. I'll hand it over to you. And if you have written remarks, if you can just send them into our committee assistance, Laurie Morris, and if you need that email address, we can get it to you.

[Speaker 10]: Yeah, I would be happy to. First, Thank you so much for the opportunity to be here with you all. My name is Julie Beath. I am an emergency medicine physician. I am the medical director of, the University of Vermont Medical Center emergency department where I've been there for coming up on four years, and division chief for clinical ops for the for the network department. And chair, how much time do I have? So I want to be respectful of everyone's time.

[Speaker 9]: We are running really behind, but I also don't want to limit you. So, yeah, we can be flexible.

[Speaker 10]: Okay. And feel free to interrupt me as we go. I'm going to try to not use too many medical acronyms and things, but, do feel free to interrupt me. And I think it's really important, just to set the stage of a federal mandate that exists for all emergency departments across the country. And that is the federal mandate of EMTALA. And EMTALA dictates that every patient that presents themselves to an emergency department is required by law to have what's called a medical screening exam. And so that means we don't and can't turn away anyone regardless of what they are presenting for, regardless of its severity or lack of severity. And that includes folks who are presenting, perhaps with very low need acute medical needs, like in the moment medical needs, and actually are suffering from homelessness and other social determinants of health that are driving that visit. And I just say that so that it, sort of frames everything else that I'm going to be talking about. But in terms of what we are seeing in our emergency department at UVM, we noticed definitely over the summertime, a couple weeks after the loss of the housing and shelters, we saw an uptick for sure in ED visits that, our most vulnerable patients were coming in with. And these were really difficult situations and somewhat preventable issues. For example, some of these folks have long term wound care needs that are better managed when they are housed and not, you know, living out on the streets, complications of diabetes, which is also, involved in wound care. Some of them have lack of electricity, and they need that electricity to deliver their oxygen. And they rely on that oxygen to survive. And then what happened over the fall, and then certainly over the last four to six weeks with the cold weather, is it's just become more and more profound. Every day, we have folks coming into our emergency department who present with a stated medical need. And some of that is accurate, and some of it may not be. And we understand that a lot of what is driving their visit is their lack of housing. And over the last few weeks, it's become even more noticeable, we see anyone anywhere from about one to 10 folks that sort of fall into this category every day. And, I was just catching the previous, woman testifying Kristen and, I have to echo a lot of what she said, there's a lot of moral injury that goes into this, when we are then faced with decisions of well, there is not a medical need for you to be any longer in our emergency department, but it's 2AM. Maybe you have wet clothing, provide we try to provide them with dry clothing, a winter coat, new boots, a pair of gloves, a hat, maybe a sleeping bag even. But there's no shelter to go when it's minus five degrees out, or when it's 32 or even 31 and raining, it's really terrible. A lot of these folks do have frostbite injuries. And so we're managing that as well. But again, that's not necessarily a reason that they would get hospitalization, for that care when in a normal situation that would be managed at home. And this population tends to have that overlapping Venn diagram with mental health disorder or substance use. And just that trifecta makes it really, really challenging to help them as individuals, when the you know, what we all need at the bottom, our hierarchy of needs is clothing, shelter, and food. And when two or three of those or even just one, the housing piece is missing, makes it really hard to deal with all of the other things that are on top of that, like the mental health, like their medical management. Some of these folks have a tendency towards violence. There's the financial impact of repeated visits over and over and over again, some of them daily, it contributes to overcrowding. Of course, our mission is to, provide medical care to everyone that presents to our emergency department, that becomes challenging. We've never done this before, we, started this winter having to allow patients to stay in our waiting room overnight, with very strict criteria, because of the moral injury it was presenting. And because we really had nowhere else to send them, and it felt very unsafe to send them out in minus five or zero degree weather. And I have immense gratitude towards our community partners, our UVM, campus police, Burlington Police Department, all of the community partners that are working really hard on this. And yet, we just feel like things aren't moving as fast enough as we all wish they could. And I'm really worried what's going to continue to happen over the next few weeks or months in Vermont with the cold. And then certainly what will happen in the future. The winter exacerbates everything. But, certainly the problem is there year round. I'd be happy to answer questions and dive into anything else.

[Speaker 9]: Thank you so much. Representative McGill.

[Speaker 6]: Thank you. Thank you. Am wondering, is Oh, Christ, I just dropped, dropped, jumped off. Have you I know this is kind of a quickly evolving situation that

[Speaker 7]: seems to

[Speaker 6]: be escalating over time. I'm wondering if you have begun to try and kind of track the actual costs associated with this issue. The former nurse who was just testifying spoke about how it appears we're saving money by cutting these services, but now folks are in our ERs, and we know that is really, really expensive. And so I'm just wondering if you have been able to start thinking about a system, or maybe you're already doing it, to get a real grasp on what those actual costs are. So we can start comparing what is the best way to meet people's needs and the best place to be serving them and the most financially responsible for our constituents and community members?

[Speaker 10]: Yeah, thank you for the question. It's a great one. We don't, I don't at least have access to the specific cost per se. What I can say confidently, is that every time someone walks into the emergency department, even with a very low acuity need, for example, let's just say they need a prescription refill, something that potentially could be handled elsewhere in the medical system, right? The cost of walking into an emergency department for care is very high at baseline, because we have to be prepared for anything to walk in. And so that's some of the cost that you know, that you see. And so Can

[Speaker 6]: I just jump in? Would it be, am blanking right now on the actual amount we're spending on hotel rooms, 100 or 80, more than $80 a night of a visit?

[Speaker 10]: Absolutely. That I can probably Yes. Yes. And I can also share we've had one individual come in one to three times per day, for a four to six week period of time requiring certain medications that are costly because of lack of access and lack of ability to store his insulin in a safe place that has reached over $60,000 And the cost that we don't measure in dollar signs is the cost of life. And we have had a death, that hit our staff really hard, in the last couple of weeks, And, it was someone who was on housed and known to us. And, that cost really can't be measured.

[Speaker 0]: Thank you. The questions, thank you.

[Speaker 9]: Thank you, Doctor. V. Really appreciate it. You're more than welcome to stay, or we understand if you have time constraints. And just as the committee knows, our schedule has gone a little awry this morning. So I'm wondering if our witness between now and if you have flexibility to come

[Speaker 6]: back this afternoon after floor.

[Speaker 5]: Sure, can see

[Speaker 6]: you soon. I appreciate that, thank you for

[Speaker 9]: your flexibility. So I just want to make sure that the witnesses remain and we have two other witnesses had to interrupt Chris, I want to make sure that they have the time that they need. We can now go to Amanda Melt I'm sorry if I'm mispronouncing your name, Amanda.

[Speaker 11]: Nope, you got that correctly, Hi. Can everyone hear me?

[Speaker 9]: We can. Yes. Welcome.

[Speaker 11]: All right. Thank you for allowing me to testify before you guys today. My name is Amanda Meltzer. I live in Winooski, and I am a non clinical staff member of the emergency department up at UVMMC. And I am also a chief steward for UVMMC Support Staff United representing clinical staff in the emergency department. So I work alongside Doctor. Vieth. And I she covered and Kristen covered a lot of what I was going to talk about in relation to us not being equipped for what we are seeing currently. I've been working in the ED for five years, and this year is significantly different than it has been in terms of the number of people who we're seeing. I work in registration, so I check people in. I land ambulances. I work the front desk, and I go room to room and collect demographic information and insurance information from the folks who are in the hospital. And I actually wanted to touch on some of the questions that were asked of the previous person about billing and about costs and visits. There are ways that the hospital is tracking the number of homeless folks or unhoused people who come into the department. My department registration, we have a work queue of homeless people that falls. I'm not entirely sure where it goes because that's not my area, but we have a box that we can check. We have a list of addresses that we know that people can give to us for their mailing address, things like Cots or Safe Harbor or the Howard Center, where we know if someone's giving us that address, it probably means they're unhoused. And we have a significant number of those people. We have people who will tell us, I don't have an address. I don't have a phone number. Here's my insurance information. And we've seen significant upticks of those since the summer. We also have my department takes billing information, so we run people's insurances. Quite a number, I would say a large majority of the people who are unhoused are either on Medicaid, Medicare, both Medicaid and Medicare, VA insurance, or they're just unhoused I'm sorry, uninsured, uninsured and unhoused, which means all of those visits that they are taking to our emergency department, essentially to see a doctor in order to get the Okay to sleep in our department overnight, not really receiving any services other than a roof over our heads. We're billing Medicare and Medicaid for those doctor hours, for those visits, for somebody to sleep in the ED, which is not a very, I think, good use of the tax dollars that we have for those people. Those dollars could be better spent elsewhere. Nobody needs to have, you know, I know a patient who has probably like $60,000 of medical debt that I can see on his chart who is a frequent flyer who we see, you know, sometimes a couple of times a day, always coming in for the same thing, that he doesn't have access to services, he doesn't have a place to stay. And we have multiple patients like that who have these huge numbers of debt numbers and are billing through Medicare and Medicaid for basically the ability to have a place to stay. So I'm happy to take questions on that. I had a little bit more to say, but the other previous people really said it more eloquently than I would probably.

[Speaker 9]: Thank you, Amanda. And similarly, if you have your remarks that you can send in to us, that would be great. Questions from committee members? Thank you so much. Again, really appreciate your time and enjoy the rest of your day. So we're now going to go back to our previous witness that we had to interrupt. Eric from Agency of Transportation. Chris, thank you so much for your flexibility and your patience with us.

[Speaker 3]: Sure, I just needed to move some

[Speaker 9]: stuff around. You have till noon, so you get most of your time back.

[Speaker 3]: I'll keep you till 12:30. How's

[Speaker 7]: that going? Good deal.

[Speaker 3]: Kidding. Alright. Right. Fumarate where I was. Well, let me just throw some numbers and then I'll get into some anecdotes. Over the last year, just twenty twenty five, my unit, my bureau spent about $126,000 on this particular issue. And those are rough estimates because it was such a new program. We hadn't assigned an EA for it in our timesheets, but we're doing that now so we can have a more accurate accounting. The maintenance bureau so I'll talk a little bit about the process, this will make more sense. We'll go out and do an assessment. And there are different types of encampments. And some are where do we just campers park in a park in our and then others are tents. So there was one up at Knapp Airport, over by Shaw's up here. There's the towers, the lights. They were people were camping in there. We can't it's it's a security issue. And they left, but they left a lot of their stuff, which wasn't considered personal property, had no value. If it does, we have a system for accounting for it. We give them receipts for it and we'll store it so that we're not throwing away valuable things. None of it was valuable. They abandoned it. And so we had to bring in a cleanup contractor and that one cost $5,000 And part of it is there some there is are hazardous materials on-site, whether it's lithium batteries that have broken, other than sometimes there are hypodermic needles that we need to pick up and clean up. So there is a cost associated with that type of a cleanup. And last year that accounted, came up to $52,000 So roughly we spent $180,000 as an agency. I would say that that's a lowball. We probably spent closer to a quarter of $1,000,000, but what I can actually account for retroactively is that, and I don't want to come in and give you a number that I can't back up. So let's talk about what happens if we go in and we approach folks, and we identify ourselves, you know, hi, I'm Chris from the Agency of Transportation. What's your name? And we end up spending a great deal of time just talking to folks before we, you know, talk about, you know, you really you can't be here. So I'll tell you a couple examples. One was in Ferrisburg. There were two campers and three trucks the park and ride right at the Amtrak station. So I went down. We called human services and said, we're gonna go make contact with folks and knock on the door of the camper. And gentleman comes out. We have a discussion for a while. I introduce myself. How's it going? First thing I said to him was as I drove up, I noticed the camper had a metal Vestas pipe coming out of it, which is for a wood stove. I said, are you burning wood in your camper? He said, yep. And so do you have a carbon monoxide detector in your camper? He said, no. What's that? He said, I'll be right back. So I went down to the hardware store and bought a carbon monoxide detector and gave it to him because I've been a firefighter since 'eighty five and an EMT, and I'm not going to just leave somebody in a situation that I know is dangerous. I asked where he was getting his wood. He was just scavenging for it. So as I'm talking to him, his 13 year old daughter comes out. And I said, where do you go to school? I don't go to school because I've been bullied. So she's being homeschooled. We have notified DCF because that particular encampment, I did give them the notice of trespass And they moved along and they popped up in Williston. So I visited them there with Howard Center. And they're like, hey, Chris. I'm like, hey, Steven. Oh, I shouldn't use their name. I'm sorry. But I am on a first name basis with almost all these folks. And we talked for a while and I said, know you. They're like, Yep, as soon as we can. I said, Okay, no pressure. And realized they had two more children. So they have three children living there now. And so they're they moved from there to another park and ride. And now they're in another park and ride. And I I'll go visit them probably next week. And they know. And so we're trying to help them out with services, but sometimes they just they don't match. And if they don't match people they have two dogs. So, that's also an issue. Let me tell you about a more successful, story. The Williston Park and Ride I went through one day, probably the third time I noticed a car that hadn't moved. And so we also deal with abandoned vehicles, and that's a whole another process, and we don't need to get into it today. But I noticed that there were people in this one, and that concerned me because it was like five below. This was about a year ago. So I went over and I knocked on the window and they there was a couple in there and a dog. And I said, hey. You guys alright? And they're like, yep. And so we got to talking. They lived there in the car. And I said, it's really cold. What are you doing to stay warm? Because the car doesn't run. That they informed me of that. I said, do you need blankets? Do you have food? Are you feeding the dog? And they're like, no. We're good. We're getting all that. He goes, I have a full time job. I'm not gonna tell you where he worked, but it was within reach of blocking distance. And I said, okay. I said, you trying to get into housing? Well, we're trying. We can't afford rent. I said, get it. And so human services got involved. Howard got involved. And what I found out is they'd been living in that car for four years. They were living on private property, a business, and then the business sold and they told them to beat it. So they came to our spot. And I am like, well, it's not a solution. So here's what I'll tell you. AOT, it was Melissa, Carl, and myself, were on regular contact with these folks. And we developed a really good working relationship where they said, and this is no slight to anyone else, they only wanted to work with us. And so we worked with Williston PD and we got them into help. Now, people say, AOT is not AHS. Right. Well, you know what? This is how we're gonna run the program. And I've pushed that upstream and the secretary gets it. And because I said, I'm not going to walk away and just pretend it's it's solved. That one was that's a success story. They're in it. There's a lot more to that story, which I'm not gonna share here just for their own protection. But we have 32 of these going on or have had 32 going on. Most of them are in the park and rides. And, you know, another example is a guy, I knocked on his door, and the first thing he says to me is, I'm a veteran. I said, really? Which branch? In the air force? I said, my dad was in the air force. And so we chatted for about an hour before I finally said, you know, you really you can't stay here. He goes, I know. Some another agency told us to come here. I said, really? Which one would that be? I'd like to talk to them. And so there's a lot of mixed messaging out there. But this is an ongoing issue. And we will continue to do what we're doing because I believe we do have a responsibility to maintain our state right of way, but also do it in a way that is professional and really treats people with dignity, who may be suffering in the worst part of their lives up to that point. And so I'm not trying to be an irritant to them, but we do have to do this. And so that's what I can tell you we do. And I'll send on the policy, but I'll also answer any questions folks you might have.

[Speaker 9]: Senator Bishop.

[Speaker 4]: You mentioned yourself and two colleagues who are doing this work. How much of your job is this? Are the

[Speaker 3]: three of you full time devoted to this work? Well, I'm the director of the bureau, but I spend 20% of my time. Carl spends 20% of his time, and Melissa, who's no longer with us, spent 75% of her time. Wow.

[Speaker 4]: Do you have dollar figures to go with those percentages?

[Speaker 3]: Okay.

[Speaker 4]: So those it looks like that would total You

[Speaker 3]: can have that. I mean, I'll you can look at it. I did I think I read that into the record earlier, but I apologize if I wasn't

[Speaker 0]: Chris, send that to him for easy. Yes. Maybe we'll get

[Speaker 3]: And, like I said, I think that estimate's on the low side because I wanna I would never come in and tell you it's up here when it really isn't because I don't play that game.

[Speaker 6]: Ade McGill? Yeah, I have two questions. Back in the September, I had a state employee for me an advertisement an internal job posting for the Encampment Response Program administrator. And you were the point of contact. That, one of the positions first, is that one of the positions you've already talked about?

[Speaker 3]: Was. Was the one I mentioned. She no longer works at the agency.

[Speaker 6]: Okay. And then in the posting, it mentions a oh my goodness, I've got to find it. AOT's homeless encampment plan. And I couldn't find that online anywhere.

[Speaker 0]: Is that something you

[Speaker 6]: could share?

[Speaker 3]: I'm going send that. That's what I'm getting.

[Speaker 6]: That's what I was great. And then my others is more, and I understand that you can't answer this. The reason people are in these park and rides or wherever they may wind up being is they literally have nowhere else to exist. I mean, live, to sleep, to hang out. We know there's a housing crisis. We know the shelters are full. There's only a certain select group of people who can access the hotel GA program. So do you have any ideas on what we do or thoughts on where they could exist as human beings?

[Speaker 3]: Yeah. Well, first, let me just say, of these 32, there are 32 different stories.

[Speaker 1]: Oh, yeah. Absolutely.

[Speaker 3]: And each one of them is compelling. And I'm not gonna sit here and recite them all because we'd be here till

[Speaker 6]: I I I worked at home with so many years, so I totally understand.

[Speaker 3]: Yeah. I, you know, I actually You might think I'm a little odd, but I enjoy having the conversations with PIO because And so I don't know that there's a single answer to this very complex problem. Do I have ideas? Yeah, I'm not sure I'm going to be the one to speak to them in this setting because I'm not here to set policy on that. I'm just here to report what we do. But, you know, it is a challenge that we as a state have. So what I will tell you is, with respect to the bill that I presumably am speaking to, which I'm not really gonna address, I know the administration does support it, generally speaking, but I would rely on AHS, the secretary of the DEPS, to address specific issues that they may or may not have. I don't know if I answered your question, but

[Speaker 6]: It's fine. And I just do wanna comment that I really appreciate the respect for, know, you have to do your job. But in your testimony, I appreciate the respect and understanding of the journey folks may have experienced to get where they are. So thank you.

[Speaker 0]: Go ahead.

[Speaker 7]: Thank you. This has been really insightful. Definitely. For sure. I was really fascinated and not entirely expecting to hear about the interesting communications and relationship between other agencies, the ones that we would kind of assume to take more of a role in the ways that you, especially these three distinct staff people have been taking on. And so I'm curious, and I know we're all a team across agencies and all, but how have these communications gone? Do you feel like they're pretty frequent? Do you think, I don't know, 20% is a lot of time in your particular role, this delegation aspect, I don't know, tell me more about that.

[Speaker 3]: So I don't think I made this clear, but I think the cooperation between the Agency of Transportation and AHS is very strong. And that's a really I'm happy to report that. One of the areas that it was a little hard to get folks to engage, believe it or not, was law enforcement. But I'm pretty persuasive, and I have a good working relationship with the law enforcement agencies where these often occur. And as far as state agencies go, the reason it's taking our time is because it's on our property. And that's not going to go away even if I am going to coordinate. I had a meeting last week with Forest and Parks. They have a similar it's a state same state And they wanted to know how we're doing what we do. And so we're meeting. And I think we're gonna see a bigger group come together or any state agency that's touching this kind of issue to make sure one of the things that I wanted to make sure of in the agency of transportation is that it's consistent. So whether this is happening in Brattleboro or Canaan or Alberg or Washington County, we're handling it the same way. I'm not saying it's cookie cutter, but that we're the expectations are clear that some people aren't treated differently because it's a different person dealing with it. And so that's really important. It's important statewide. But I think we have the lion's share that's going on and that's why. And part of the time, I'll be honest with you, part of my time is checking in on people. Because I don't go in the first day they show up and say, you need to get out. I'm like, how's it going? And I did I probably shouldn't say that the secretary might call me after, but I gave people a reprieve during Christmas. I'm not gonna go in and get out the day before Christmas. In fact, I'll tell you some of the staff may have bought, given money to one of these people so they could buy Christmas presents for their kids. That's the kind of people that work with me and at the agency.

[Speaker 4]: With respect to relationships you have within state government, law enforcement, etcetera, I imagine there's some relationships you establish with municipalities. Yes. Because your problem, your problem can be solved if they move a 100 yards off of a park and ride, but then the municipalities land may be implicated.

[Speaker 3]: So can you tell us a little bit about the relationships there? So I have a good working relationship with your police chief. But what we don't do is go in and say, hey, if you go onto town property, it's all

[Speaker 0]: good. Yeah.

[Speaker 3]: What we do work with human services to say, hey, what's going on here? And what's the barrier from getting you into housing? Or how can we figure this out? One of the folks that we're dealing with, they're trying to locate their sister who has land, but they don't have a computer. So we're trying to help facilitate that. But we don't push people to town property. At one time, they did go to Fish and Wildlife, one of the access areas. And I don't know if you know, I used to be the Commissioner of Fish and Wildlife. And they called me and said, hey, did you send this And guy because he said I did. Because he he goes, well, Chris told us to come here. And they're like, Chris, And then they knew. But he also told them that he only moves if I give him gas money, which is not true. I never gave him gas money. And so but what I've tried to do in that community of folks who are involved is make myself the point of contact. So, the police call me. Williston, we met with them. We were meeting with them weekly because that park and it's again, it's turned into a campground up there. And we just need to go up and start moving, working with folks there. But I haven't heard of many of these VAR folks, I say our folks, the folks that we deal with going onto town property.

[Speaker 4]: Thank

[Speaker 3]: you. But I make myself available to whenever we go into a town, we notify law enforcement that we're there, whether it's the sheriff's department or a local PD or state police, so they all know who to call.

[Speaker 4]: I appreciate you calling out the positive relationship you have with our chief.

[Speaker 5]: Thank you. Thank you.

[Speaker 9]: Other questions? Really appreciate Appreciate your your flexibility.

[Speaker 3]: I'll send you some information, and if there's anything else you wanna know if you of it, I'm pretty easy to find christopher. Herrickvermont dot gov. And good luck. Have a good day, folks.

[Speaker 0]: Maybe before we break for lunch, just a reminder, we have the joint hearing with HealthCare, F1, in Room 11. And we have, I believe, rescheduled Chad for this afternoon after four. So we're What? Okay. So we'll I do have the calendar.

[Speaker 9]: So just look for a text from the chair or myself about what

[Speaker 0]: the