Vermont Legislature SmartTranscripts:

[Unknown (meeting staff/host)]: Our first witness is not here. So we're gonna move to the sec oh, and our second witness is not here.

[Rep. Theresa Wood (Chair)]: Yes. He's oh, he's on. Okay. Kelsey, you're gonna get to go first. So welcome. Welcome to Northeast Kingdom Day. So and, Kelsey, I I am, glad that you made the decision to stay in the kingdom today and not make two trips to Montpelier in the same week. So our first witness is not in the room, so bonus, you get to go first. So thank you so much for being here. Folks, And I'll let Kelsey introduce himself. But we'll do a I'm thinking I'm gonna wait until the second witness. Then we'll do introductions because I think we'll have more of our committee present at that time. So go ahead, Kelsey. The floor is yours.

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: Great. Yeah, always love being down in person, but I also feel a little under the weather, I don't want to share that with you all. So glad there's a virtual option. So thank you for having me in and hosting folks for any today. My name is Kelsey Stabsef, and I'm the executive director of Northeast Kingdom Human Services, which is the local community, mental health and designated also co president of the Vermont Care Partners, Ward. And so, I just wanna take a few minutes to talk about what's happening in East Kingdom related to human services, and we've got some folks who are, gonna speak to some other things happening in our area. But the first thing that I really wanted to highlight is that one, Northeast Kingdom is 2,000 square miles and covers the three counties of Caledonia, Orleans, and Essex. Essex is the most remote county, and one of the challenges that we face is that remote nature and just having access to services. And so I just want to highlight going from a state, but the Northeast Kingdom is the rural part of the rural state. But one way we overcome this is through partnership and collaboration. And so I really wanna lift up what the Northeast Kingdom has done through community partnership. And so a little while ago, we so the hospitals, the FQHCs, and now designated agencies that are becoming CCBHCs are required to do a community health needs assessment every three years. A little while ago, we got together and said, why are we all doing this separately? Can we do it together? And so, Northeast Human Human Services, Northeast Vermont Regional Hospital, North Country Hospital, Northern Counties Healthcare, Northeast Kingdom Community Action, Northeast Kingdom Council on Aging, and the Vermont Department of Health all came together to do a regional community health regional needs assessment. And so one reason this was really helpful is that when we're looking at prioritizing the needs of our community, we have one source, so to speak, that we can all refer back to when we have to decide how to spend scarce resources on the most important things in our community. That, Community Health Needs Assessment raised up four different areas that were most important: mental health, social determinants of health, chronic disease, morbidity and mortality, and substance and alcohol use. And so, not only do we do a community health needs assessment, but we also have an accountable health community that meets every month. The backbone is, NVRH, but that gathers the organizations that I listed and more. They come together monthly to tackle the issues highlighted by community members. And so I just wanted to highlight the collaborative nature of the kingdom, not only because we believe in that, but because we have to. Again, there aren't so many of us over here. But I do think in some ways, we're leading the way in how to collaborate, how to use the regional supports that are in our area, and how to make an impact in our community. And so just, you know, our organization, the designated agency, we do mental health for adults and children. We support individuals with developmental disabilities. We do emergency services. And so when you hear that, you know, we want to focus on providing those treatment supports that are associated with mental health, we think about therapy, case management. But I had mentioned before the social determinants or contributors to health and saying the folks that we're working with, yes, can have underlying mental health issues, but sometimes the root cause goes beyond those issues. And so just to give you a better understanding of some of the underlying tensions that can contribute to mental health or other challenges, saying eighteen percent of the people that we work with have had their utilities turned off in the last few months. Twenty four percent say they have transportation issues. Eight percent say they fear for personal safety. Ten percent have difficulty accessing health care. Thirty seven percent say they have financial hardship, twenty percent are food insecure, and about twenty percent are household. And so, again, why we talk about the collaborative nature in the kingdom is that, yes, there are associated anxieties, depression, early intervention issues that we're working on, but with these underlying issues, we're often tackling problems in the family system. And so we have to rely on each other to make that happen. A couple other things that I wanna highlight quickly too is saying that one of our goals is to be innovative and saying we're not functioning in a bubble, saying what are the most pressing issues facing the kingdom and Vermonters. So we talk about education reform. We talk about health care. We talk about public safety. And so we are certainly involved in all of those. Two programs that I wanna highlight. One is the front porch, which, we've been having for a couple of years, but have recently just fully operationalized. So we have four crisis stabilization beds. This is in Newport, Vermont. And then we have a twenty four seven walk in, for mental health and co occurring issues on CS and PS services. We've also partnered with the St. Johnsbury School District to start a collaborative program. This is unique. We use Success Beyond six, which has been around for a long time. But what we've done to change it is that we've built a collaborative program in town in case of the building, but the school runs the school and we provide therapeutic options. This is a small pilot program, but we preventing kids from needing independent therapeutic placement out of district, which can be expensive and also has high transportation costs. So this keeps kids in the area, allows them to transfer back participate in the public school, and we think is one way to help address rising costs associated with special education. The last thing that I'll note is that in partnership with our local other health care partners, We have used our expertise to help embed suicide safe pathways in hospitals and primary care, and that's through our emergency services program and specifically named Josh Burke, as someone who's dedicated a lot of time working with our partners to improve how we address people with suicidal ideation and how we support them, not only when they show up at organizations, but also beyond that. So I know I only had a few minutes, but just want to say collaboration and community coordination is one of the strongest things we've got going in the Northeast Kingdom. And I think we have a lot to offer in terms of how we're addressing some of the health care costs, education challenges, and other issues facing homeowners across the state. So thank you for having me. I appreciate it, and it's good to see everybody.

[Rep. Theresa Wood (Chair)]: Thank you, Kelsey. I hope you feel better, and I think we were pretty impressed with the

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: front door, front porch. What would

[Rep. Theresa Wood (Chair)]: you just call it? What is it?

[Rep. Bert (first name unknown)]: Front porch. Yeah, call it front Yeah,

[Rep. Theresa Wood (Chair)]: the front porch last year when you testified around public inebriate or detox kind of situation. So thank you for being here this morning. And we're going to flip back to Carrie Staller, which is going to precede his pantry. So it kind

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: of fits in. Wow, and be all right, actually. I

[Rep. Theresa Wood (Chair)]: was just going to say, we're all here now, so we're going to do introductions around the table and around the room. So my name is Theresa Wood. I live in Waterbury. I also serve Bolton, Buellsport, and Huntington.

[Rep. Anne B. Donahue (Ranking Member)]: I'm Anne Donahue from Northfield, also serving Berlin.

[Rep. Daniel Noyes (Clerk)]: Morning, I'm Daniel Noyes. I represent Woolkit, Hyde Park, Johnson and Belvedere.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Hi, good morning, Eric Maguire, representing Rockland City. Brenda Steady, Wexford, East Mountain.

[Rep. Bert (first name unknown)]: Good afternoon,

[Rep. Zon Eastes (Member)]: full chest.

[Rep. Bert (first name unknown)]: Every day and meal plan,

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: every night's brand new cars are down.

[Rep. Zon Eastes (Member)]: Morning, My name is Zon Eastes. I live in Goethe and I represent Maryland.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: As Michael LaBarcliffe. Jubilee McGill, and I live in Bridgeport and also represent Middlebury, New Haven, and Woodbridge. Hi, I'm Rey Garofano. I represent Essex and Essex Jubilee Shench.

[Rep. Theresa Wood (Chair)]: And then we're gonna start right here on the windowsill and go all the

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: way around. Amy Lester, and I'm here. I live in Plainfield. Great, welcome. Lori? Alright.

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: For your more

[Rep. Esme Cole (Member)]: Spitting Assistant?

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: Please welcome, community member of Comfort Limon. Great.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Miriam Tatum, I'm a community member and retired pediatrician from Durban. I'm David Flemishow, community member from West Charleston, Vermont. I'm Rebecca, I'm from Barnite. I'm Julia Demets, work for St. Johnsbury Community Health and I live in West Barton.

[Rep. Zon Eastes (Member)]: Good morning, Brianna Houston, NBRH Substance and Disease Prevention and Vermont National Guard of Time and Drug Program.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: I'm Steven Hickey, I'm from the Northeast Kingdom, and I'm associated with the open mill site in Barfoo, and I'm here to see democracy in action.

[Rep. Esme Cole (Member)]: Great, thanks.

[Rep. Theresa Wood (Chair)]: Well, it's wonderful to have so many people from the Northeast Kingdom here.

[Rep. Esme Cole (Member)]: And I'm here with the Food Bank.

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: I also refer to the PCC's M and TAP agency.

[Rep. Theresa Wood (Chair)]: Okay, great. Thank you. I didn't see you come in and sit down. So, Carrie, welcome, and please introduce yourself. And I'm just letting folks know that we have an amendment on one of our bills that we have to hear this morning. So we're going to try to adhere to our schedule pretty succinctly. Appreciate your comments, and we'll look forward to connecting with you in the building as well. But we are going to need to kind of like be brief.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Got it. Thank you. Good morning. I'm Carrie Stailer. I'm the senior manager of government affairs for Vermont Food Bank and a resident of the Northeast Kingdom. I live on the Linden Kirby Line. I'm actually here, Kelsey did a great job of talking about a lot of the connectedness and collaboration that I was going to discuss in my testimony. So I will simply build a bridge between Vermont Food Bank and the Northeast Kingdom. Vermont Food Bank has been involved in the Northeast Kingdom for a number of years. We were a founding member of NEK Prosper, which is the accountable community for health at NVRH, and are still members of that leadership team, working collaboratively with all of the organizations that Kelsey mentioned, to think about all of those root causes to poverty, to food insecurity, and to health in that region. We are also a member of that community at North Country Hospital, which is a slightly different version of the community for health. And one of the things that I wanted to highlight for this committee that Kelsey also mentioned is that challenge of transportation. We see that through the food bank. Part of our work is logistics, moving food around the state. It is particularly challenging in the Northeast Kingdom. We do not have as many partners per square mile in that area. And it also lacks a lot of real community hubs. It's hard for people to get even to St. Johnsbury or Newport, which are really far apart, even though we talk about them as though they coexist. And that's why we have to rely on rural partners like Sid's Pantry, who you'll be hearing from next, the Gillman Senior Center over on the New Hampshire line, Island Pond has NECA location. NECA is an incredible partner. They also operate Newport and St. John's Berry food shelves that we rely on to help get food out to community members. And then a little bit later, you'll hear from the community health team at MVRH. Those are our site partners for that Caledonia County's Edgy Bango, which used to be at the hospital. They're under construction now. So we've added a partnership with Vermont State University at Linden I've added a walk up option for students to come and get produce from that event. So really, that collaboration piece is critical where we live and where we work. And I think you'll hear that a lot better from the partners here today than you will from me. So I'm gonna cede the rest of my time to folks and welcome Denise to the chair. Thank you.

[Rep. Theresa Wood (Chair)]: Thank you so much, Carrie. And I do wanna highlight what Kelsey said, and it impacts everybody else who is following it. And that's the collaboration on the state. I'm not sure exactly the title, state health plan, region needing to do a health plan, a And community health I was delighted to hear all of those organizations who all have requirements to do the same thing, do one plan, one assessment, and that how they implement those needs could vary by what their role is. But having one assessment for the region, I hope that other places do that. I don't know that they do, but you serve as an example.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: So thank you. Yeah. And I will say, we've talked about data with this committee before. That is data that the food bank uses to identify gaps and opportunities. So we, too, utilize that data that those organizations are collaborating on, and it is really, really helpful to us to have all of that in one place as opposed to seven different ones to check out. Exactly. Thank you. Yep, thanks so much.

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: Welcome, Denise. Good morning. Morning, committee. I thank you for allowing me to speak today. I'm Denise Walton, and I'm here today as a resident and community member of Concord, Vermont. I'm also an advocate for our local food pantry, Pantry, which is housed at the Concord Health Centre, run by Northern Counties Healthcare. SIDS Pantry serves approximately 60 families of all ages. It's a monthly pantry and it's held along with the past offerings of an additional veggie drop, a lunch pop up style in the summer, and all these projects have been made possible with Vermont Food Bank programs and or grants, and many volunteers gave their time. I'm here today to ask you to fully fund Vermont Food Bank's request for the $5,000,000 budget in FY twenty seven. With $2,000,000 for the Vermont Feeding Vermonters program grant program, 2,000,000 to support Vermont Food Bank Network food shelves and meal sites, and $1,000,000 for ready response food access in emergencies. In my community, have a population of almost 30%, 65 and over. Most live alone and have limited local families. We are a very rural area with no public transportation and a small convenience market, but no grocery store, unless one travels to New Hampshire or St Johnsbury. The current population is approximately 1,669 people, with 16.9% at poverty level. It's a perfect community partnership for Cids Pantry to be located at the Concord Health Centre. Food access is available during health centre open hours and patients and residents of Essex County get a referral to the pantry. Produce, which is always of the highest quality, comes from Vermont's Food Bank and our monthly pantry drop, and is supplemented with our Food in Vermonter brand, which is used to purchase food, fresh food from local farmers, eggs, cheese, milk, dairy, and it's all supplied by Vermont Food Bank with our monthly deliveries. Each month the shelves are stocked with staples, rice, pasta, canned goods, and always applesauce. These are ordered and paid for through various brands. Our community itself is very generous. During the year, we have a big food drive at the conference school. Miles Quan Association donates at the end of the summer as they head out and empty their summer camps. And the health center sponsors the turkey trot, and we have a local group that they spread for the holiday baskets. This is all part of my community, our community, and part of many communities in our state, within our state, as we see many more in our communities are focusing on these projects of survival. We are proud, we are humble, and in our current status, we are in need. We ask that you please consider funding the Vermont Food Bank request, budget request. Lastly, I'll talk about right in response for floods, ice storms and emergencies. I myself have experienced one of these emergencies on 11/01/2025. With the government shutdown, there were no EBT benefits paid out to anyone. As an elderly disabled person, I qualified for EBT. With a tiny window of higher knowledge and preparedness, I was able to grow my own sprouts, make soups, and make do. The store was vacant that day as I entered to get with my two ingredient lists. I saw the shelves piled high with things that I could not have. Fresh veggies were wilting as there was no one there to buy them. The meat department bulged with its load. That feeling, it ignited me. I made do, but the families, the kids, our elders and our veterans, would they make do? Could they? In response to this federal emergency, one week later, Vermont stepped up and helped its people so we wouldn't have to make do. Elders could have more than tea and crackers for dinner. Kids could go to bed with a full tummy. Thank you. I thank you. We thank you for the action you took as legislators to ensure those of us who needed help in November, goodbye, were able to have our benefits, our money to buy groceries, and food shelves were able to continue to supply to their neighborhoods. That support was critical. That showed people like myself that you also believe that poor folks, we do not have to suffer, we do not deserve to suffer, and we deserve to ask and have choices of fresh, healthy foods and safe, adequate programs to access these foods. I recently was surprised to learn that each month the Vermont Food Bank and our partners serve an estimated 70,000 people across Vermont, with 14,000,000 pounds of food delivered. Two twenty two farms are supported by Vermont Food Bank, and two seventeen network partners shared food with neighbors. In closing, it is with gratitude that I am here today and ask you to please consider full funding for the FY27, for the healthy well-being of the residents of our communities of Vermont. Thank you. Thank you

[Rep. Theresa Wood (Chair)]: so much, Ziz. And thank you for sharing what it was like on a personal level in November. We weren't in session then, but the legislature acted. And I appreciate really hearing what it felt like out in the community at that time. Thank you so much. Next, we're going to hear from the hospital. We're going to hear from Crystal and Erica. I was going say, you're welcome to be there together. And for anybody who actually had prepared testimony, if you haven't already sent it to Laurie, would you please send it to Laurie Morris so we can post it and other people can read it? Because it's really helpful and important to inform what's happening out in our communities across the state. So thank you so much. Welcome.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Thank you. Thank you for your time this morning. My name is Erica. I am a resident of Southern Vermont, and I'm a proud community health worker at Northeastern Vermont Regional Hospital. This is my coworker, Crystal.

[Crystal Bigelow (Community Health Worker, NVRH)]: Hi, my name is Crystal Bigelow. I'm a community health worker at NVRH. I'm a resident of Windhamville and proud voter in my community. Thank you. Good to hear.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Yes, and navigator with Vermont Health Connect also. My supervisor Deb and I are site coordinators for the Vermont Food Bank of Edgy Van Gogh Drop, Vermont State University, Linden. Half a week facilitate that with the food bank, And my role there is to help coordinate the volunteers to the food distribution. Doug does traffic and data collection. We have acknowledged an uptick in anxiety and concerns about food insecurity from consumers picking up in the veggie mango line. At our Linden drop, we are serving three fifty to 400 families per month in that line. We're seeing a very diverse population. People are expressing that they're picking up more chairs just to help their friends, family, and neighbors. We hear words of gratitude towards our volunteers at the food drop and excitement for the variety of foods that are being given out there, the hardiness of the foods during different times of year. Two older Vermonters get particularly excited about the beets, eating them and candying them. Say beets?

[Rep. Theresa Wood (Chair)]: Beets. Oh, that's what I thought, okay. There

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: is one gentleman that says each time, Thank you for your service. Thank you for your time here. He's very thankful for us. We're seeing an increase in community partners volunteering alongside of us. We just had the probation and parole was there the last few months with us helping out. So we're seeing different community partners come and join us to help and see the food insecurity that our communities are expressing. We also have a local agency that has partnered with the food bank to have a food drop at their housing site to more directly serve those of their populations that are experiencing barriers to get to the food drop. As community health workers, we work to help connect families to resources and that's to help address their needs such as food insecurity. We frequently refer families to commodities, veggie van goat, food shelves, and even connect to schools that we're collaborating with, that also collaborate with the food banks so that families can access food that way, which addresses the transportation barriers as well for seeing kids. Touching families where they're at. Working with families, we would like to share some stories of experiences that we've had with community members that live among us and serve as a community health worker. I have received a referral from a provider at one of our local primary care offices for a woman asking if we could purchase her a glaucometer to help manage her diabetes. She was struggling to do so. So we met with her and we kind of went through the intake to just talk more about what her need was. And in conversation, she shared that within her community, she was actually at the laundromat and sharing with her peers that she receiving COVID's benefit. She didn't understand why, and her peers believed that due to, out there from parent incomes, she should be eligible. So we discussed that, and I also believe that maybe she should be eligible. And she actually believed that due to her rates is why she was not receiving benefits, because her peers at lower incomes, higher incomes, similar incomes were receiving benefits. So we reached out to the local economic services, turns out there's this little checkbox that you have to check on the application that she missed. So they didn't screen for the benefit appropriately. So we redid the application, which she was really joyful about to learn that she was going to be receiving the benefit. And the intern actually said, thank you for your support. However, I don't need funding to buy a wood powder. I know how to eat balanced meals. I didn't have the resource to do so. So that gave her the ability to access balanced meals to help control her chronic illness. And because of that connection, she also believed that maybe that meant she couldn't reach out to other food networks and so hadn't. So we had a great conversation around her, the accessibility to being able to do that. And I have another story to share with you all. We're seeing an increase in those experiencing financial insecurities due to the high cost of living, and things such as increased healthcare premiums in Vermont. A 36 year old single teacher walked into our office looking for help because she was losing state and federal tax subsidies to help cushion the cost of her her affordable premium at the time. That means this teacher earning a little over $30 an hour is above the income threshold for Vermont Health Connect and is no longer eligible for help to pay for her monthly premium. She would now be responsible for a premium above $1,300 per month. With rental costs so high, she would be paying out half her gross income for housing and healthcare alone. Patient was crying in my office wondering how she would be able to afford food for the month. Scenarios like these are happening almost daily in our office, in our community and statewide. The ability for consumers to access low barrier food resources such as veggie ban go programs out of the Vermont Food Bank are essential resources to help cushion the high cost of living. Thank you for your time today. Thank you. You.

[Rep. Theresa Wood (Chair)]: So people were so succinct and followed so well that we have some time for questions from the committee, if you don't mind, for any of the witnesses who came this morning. So I have one. And so when you say community health worker, does that I can envision what that means. Are you a social worker? Are you a nurse? Are just trained in community supports and services? Could you explain a little bit what that means?

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Yeah, great question. We are neither a nurse or case worker, a community health worker, a standalone role. There is a movement and efforts. We do have a community health worker association in Vermont. So we're taking the steps to-

[Rep. Theresa Wood (Chair)]: Recognize as a profession.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Yes, absolutely. So I think that NBRH in the Northeast Kingdom, there's large support for what a role of a community health worker can do. We have that time, especially in the medical side of things. We have more than the fifteen minutes that a provider does at an office to really look at the social determinants of health for each family, determine what their needs are, and help connect them to those resources and services really appear with the people that we're connecting with. Great, represent Steady. So who's your employer? Who do you get paid? Yes, absolutely. It is not. We are employed through Northeastern Vermont Regional Hospital. I don't know the details around the funding. Some of our funding does come from the Vermont Blueprint. Not gonna read all the details, I think we are a small section of funding that comes from Vermont Health Connect. We are part of that. There's very little that is handed out from that, but

[Rep. Theresa Wood (Chair)]: Getting smaller every day.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Reps Anne B. Gill. Yeah, you see you, in some of the stories you shared, you talked a bit about helping folks navigate the various benefits. Is that something you find a lot of people needing assistance with? Absolutely. In our office, we have a walk in option. We can receive referrals. People can walk in, people can call. So we have a high flow of traffic of people walking in saying, I need this, this is an issue. I have food security, I don't have financial security, where do I go? And I've heard this morning a lot about collaboration. Collaboration, we can't do it alone. We have to be educated about what our community offers and collaborate with all the resources, many in some of what you see sitting in the office room with us. So yeah, it's an honor to be able to hold that role and help connect and collaborate. We do still have a walk in door, so we're like one of five in the state of Vermont that people can just walk in without an appointment to get our services. We have three community health workers and a lead, and we initially do a full intake. So we ask all of those questions, right? And sometimes we share something with them that says like, do you have any other questions? And we oftentimes tell people, I tell people often that if they're not sure who to call, give us a call. If we can't connect you to someone, we can help you in our office.

[Rep. Theresa Wood (Chair)]: So either way. Great. I have a question for Denise. First off, I wrote down projects of survival. That feels like that's kind of like a mantra here in this building this year. So if you hear yourself quoted, you'll know that That's pretty exciting. Thank you. I'm curious, it seems from what I've heard from other food pantries, food shelves, local some people rebranded themselves as local markets That there seems to be, I guess, especially as the food insecurity appears to be rising in the state, more formalization, I guess, of of these community resources. So locally, I know that you have to fill out an application. You have to pay They're taking down information where, in the past, might have been a little looser. Do you know what I mean? Is that something that you do at your food pantry? Or do you know about what's happening in the other local communities?

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: Depends on which role someone is taking on and volunteering, specifically where we just work with the general public. We don't have like a background. You have a board, so there's different roles and different levels. So I think I'm seeing a lot more of a collaborative, people who are helping the people and they're wanting And you know, you have to be

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: careful if people do

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: want to donate things. We've had a gentleman that had come online with a whole truckload of bread and to donate to Sid's Pantry and to community. We just have to make sure,

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: I mean, can't call it, but we do, we try to deal

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: with good quality foods and things. We have recalls, you know, there is some sort of, with the Vermont Food Bank, they have wonderful recalls, you know, so we can check things, we can let people know.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Cheryl, do you need neighbors?

[Rep. Theresa Wood (Chair)]: I did, I met community members that might be coming in to receive food.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: So we have people come to this to get food from Yeah,

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: we have a basic form that you know what county you live in, your address, and they don't even have to do their address, and if we

[Rep. Esme Cole (Member)]: have people that come in that

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: aren't from Essex County, we'll say yes we're here today, but this funding is you know physically for the county, here's a list of resources and that's where that collaborative comes

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: in because they're here, there

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: and everywhere. We allow people to pick up, you know, for other people, just, that is

[Rep. Theresa Wood (Chair)]: a barrier with the transportation. Transportation.

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: And that's why some of those things like the, you know, bringing the goods from Zon bringing that into there, people could get them there. At least

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: you could get to the

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: proper health center because they know where to.

[Rep. Theresa Wood (Chair)]: Thank you. Representative Steady and then Representative Cole.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: So the $5,000,000 can I get a breakdown sent to me of where that all goes? Values, food?

[Rep. Theresa Wood (Chair)]: So Representative Steady, we're going to hear about that during FY '27 budget testimony. Okay, so then Representative Cole and then Representative Donahue.

[Rep. Esme Cole (Member)]: Thank you. You. Thank you. You are on the front lines and filling the gaps where other areas of marketing or government have failed us, basically. So thank you, bottom line. My question has to do with, it's pretty striking, that one checkbox, how big of an influence that it had on somebody's life for quite a while, and a ripple effect really. Was working at a senior center doing EBP type applications as well, and I only learned halfway through my time there that there was a specific form that could be used to expedite the seniors. I don't know, just want to

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: make sure that you all are aware of this too.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: It's a little bit

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: shorter ABT snap. Exactly. But it just goes

[Rep. Esme Cole (Member)]: to show, in terms of administrative barriers, can we do? Maybe we could have input to influence why somebody in the subject matter or whatever. Love your insight on that.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: I think one thing we're finding is everybody's in a hurry, right? So if we can get them in there, like they come in with an initial ask. And sometimes that initial ask is like, need help. Right, but we need to have a financial conversation before we need help you get into housing also, because we gotta break down some more barriers first. We try to take a look at what, somebody comes in with a need, that's what's important to them. Finding housing or another need might be important for them, but we all work in what's important to us. So that's where we have to focus. And I think having the opportunity to have someone to sit down with that's familiar with an application and the process is a highlight. It's incredible, just as an example, with Medicare open enrollment. We aren't educated in Medicare and people were flowing through our doors. So not having that one on one support, it's crucial to have that.

[Rep. Theresa Wood (Chair)]: And where did you refer them?

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: So we have Council on Aging. They were completely booked up in our area. So it was Medicare directly. And that was not an ideal, not ideal sometimes.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: Yeah, so

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: I think just having one on one support with having that offered. I know in many cases people are handed an application to go fill it out on their own. How can we offer them that support? We can help them fill out those applications in our office like the 205 AllMed for the people on Medicare. It feels good. We can provide that support to at least help them fill it out.

[Rep. Theresa Wood (Chair)]: I'm gonna answer myself just for a quick question. Just because we have a wealth of experience and information here. So one of the things that I know we have coming before us in FY twenty seven is a request from community partners for I keep on calling me explainers, but that's not what it's called. So when you were talking about that one on one assistance, as the Medicaid changes come into play where people are going have to apply twice a year, they have to approve a bunch of different things, are you seeing a need in the community for more support to assist? I'll get the assister thing in there. To assist people to understand what these new federal changes mean to them personally.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: We have about 175 assisters in the state right now. There's tons of people on board to get that education right now. They just did a training for like 300 people in one part of the state.

[Rep. Theresa Wood (Chair)]: How the training?

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: For My Health Connect. It's offered by For My Health Connect. So that's fantastic to have everybody on board and we have collaboration with different assistants in the state, so that's nice. We're not alone. But also, it is going to be a burden on us to, you know, that increase in traffic, anxiety for people, that's gonna create a lot anxiety. Right now I have to provide my income more than once a year. People refer to tax time, that's once a year, so I get all my stuff together, I figure that out. I think it's gonna bring great knowledge to people about their income and changes that are coming or that have happened. So that's good. Or people that want to move monies in different areas. So I think it'll be good, but I think it's going to be, there's gonna be a lot of anxiety and concerns that comes with that, which is gonna turn into a lot of traffic, phone calls to try to suppress some of that. And we have three community health workers in our office where all three of us are sisters with Vermont Health Connect. And over a third of the work that we do is insurance with Vermont Health Connect, Vermont Medicaid, qualified health plan. So already that's a third

[Rep. Theresa Wood (Chair)]: of it. It's big part of what

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: you do.

[Rep. Theresa Wood (Chair)]: Yeah. Representative Donahue. Representative

[Rep. Anne B. Donahue (Ranking Member)]: Donahue. Thanks. Just in this part, it'd be anybody who might generally know this is based on what I've seen happen in my town and so forth. Wondering if you have a sense of how much of food access is able to be delivered through people making choices saying this is something I would use, this is something I wouldn't use versus a box of items and this is your I got that one. Because I know the administrative burden is far greater to try to individualize, but you know. Yes and no.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: To get the volunteer labor together to pack a box of food and then distribute those, which are

[Rep. Esme Cole (Member)]: heavier, bigger, harder for people to carry back into

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: their own house, that's a challenge. And at Vermont Food Bank, we recognize that literally what people are asking us not to do. People want to make their own choices. They want to be able to walk into a food shelf. I think the real challenge comes when food shelves and food pantries and meal sites are not the grocery store. We are not a replacement for the grocery store. We don't want to be a replacement for the grocery store. That's why programs like Three Squares are so critical. They give people that dignified choice of a whole spectrum that's available, as opposed to what we are able to access and distribute and what our food pantry partners are able to stock on their shelves when sometimes they're in a little tiny corner of a parent child center, you know, where it's like you can go once a week or maybe once every two weeks, right? And it's just meant to fill the gaps and to fill an urgent need as opposed to offer a really broad variety of choice. I will say that is where some of the events like Veggie Magnum come in, because a lot of people want more access to fresh food. It's a riskier purchase, right? It might spoil, you might not get a good one, it might not be available, right? And so having those things, it's more expensive, right? Having those things available at no cost to people is helpful and helps to fill that choice gap. But we do operate programs where we're required to give people a box, right? The commodity supplemental Yeah, right,

[Rep. Anne B. Donahue (Ranking Member)]: and I was just wondering very roughly how much food access is able to be through one form or the other.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Would say mostly it's by choice. There are a few partners that we work with who only do food box ordering,

[Rep. Esme Cole (Member)]: if that's what their capacity is.

[Rep. Theresa Wood (Chair)]: I want to extend my sincere gratitude to everybody here this morning and making it down from the Northeast Kingdom, a beautiful, beautiful part of the state where I have lots of family. I spent a lot of my childhood in the Northeast Kingdom. So greatly, our whole community greatly appreciate you being here and sharing the community that you have there and what it means to be part of that community. So thank you so much for being here.

[Rep. Esme Cole (Member)]: Thank you. Great.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Thank you all.

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: Thank you.

[Rep. Theresa Wood (Chair)]: Okay, committee members, we are going to transition now to hearing an amendment on H545. And we'll just let sort of the room kind of dissipate a little bit. Representative Bert is here to present his amendment. We will I think there are people probably out in the hallway who are waiting to come in. Thank you. I'm just going to take a couple of seconds as the leave and then the other people come in. I know there are people waiting out there to come in. Okay, good morning, Representative Bert. Welcome to House Human Services. You didn't have to go far. Right. So committee members, we have an amendment from representative Bert. It's under Katie McLinn's name on our website and Legis Council will be here shortly to kind of review the content. And Representative Bert here is here to review his amendment. So welcome.

[Rep. Bert (first name unknown)]: Thank you for having me in your break time, so I appreciate it. Yeah, so the amendment is

[Rep. Theresa Wood (Chair)]: Well, we all have it, so you don't need to maybe you could just describe, Representative Bert, why you want what's causing you to bring the amendment.

[Rep. Bert (first name unknown)]: Yeah, so well, of all, the first part, it says it's a strike all amendment. It really just adds one number to the part, and we will not make any changes to the first part in Part C. What the amendment adds is a disclosure to the patient that the healthcare professional is immune from damages associated with the recommended immunization itself. So we want to make sure that the patient is aware that there's additional or need for the healthcare professional, and why that's important is, I'm just going to read my notes, but so I'm trying to

[Rep. Zon Eastes (Member)]: back and forth here.

[Rep. Bert (first name unknown)]: Age five forty five provides framework for the state to provide recommended immunizations apart from certain federal guidelines. In so doing, it is important to establish how that affects liability for the healthcare professional, which Bill does. Bill does not, however, address the reallocation of risk that is inherent to establishing immunity toward a healthcare professional. The patient inherently takes on greater legal risk from this bill. Because of that, is essential that a disclosure regarding the immunity of the healthcare professional be given to the patient before administering the recommended immunization. Wrote, I actually wrote that in self. Did not pull that off.

[Rep. Theresa Wood (Chair)]: No chat GPP or Gemini.

[Rep. Bert (first name unknown)]: Send it to them. Know. Because there's some intelligence. Yeah, I just want to make it clear to the patient that this is an additional form of immunity that this bill is introducing for the healthcare professional, which I think is wonderful. Just making sure that the patient knows that there's an additional immunity there. So there, from what I see legally, there is a shifting of risk that happens being granted inherently. Some of that is going to be on the patient, so I think it's important to still assess the patient. And I know there's another title 18 that does informed consent, it says nothing about their liability of the health protection. So I think maybe some updates to that should happen. I actually have the film in house care about a small update to the bill records, but I think there's room for some

[Rep. Zon Eastes (Member)]: other updates.

[Rep. Bert (first name unknown)]: And it specifically talks about treatments in there. I don't know where, I'm assuming it recommended immunization being administered as a form of a treatment, but I just think given the nature of what this bill is doing, that it's important that right where it talks about immunity for the healthcare professional, which I said I think is a good thing, it also makes it clear that there's a reallocation of risk and therefore there needs to be more information and disclosure given to the patient.

[Rep. Theresa Wood (Chair)]: And I'm just curious if you're familiar with the federal program that individuals can access if there's an adverse reaction.

[Rep. Bert (first name unknown)]: Yeah, Are you specifically talking about bears?

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: Yes.

[Rep. Theresa Wood (Chair)]: Thank you. So questions from the committee. Okay, so I saw Representative Cole first and then Representative Bishop.

[Rep. Esme Cole (Member)]: Thank you, Bedford. Are there any other parallels to this strategy in other areas of medicine or healthcare, if you think?

[Rep. Bert (first name unknown)]: With medicine and healthcare, I'm not sure, but I mean, certainly in contractual legal framework, that's a term like contractual reallocation of risk. Bear with me if I'm going to use the example of somebody who sells cars, I don't want to have that be a comparison with a patient, but if someone is selling cars, it's important that they inform the buyer of what the warranty entails and so forth, and the buyer signs on to that in a contract when they purchase the vehicle. If we make a law that says, well, we want to make it easier for, say, for the

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: we want to make sure

[Rep. Bert (first name unknown)]: that cars are easy to buy and sell in our space, so we decrease the amount of liability that could potentially be on someone who's selling a car, and it's important that in our statute, in my mind, that we also make it clear to the buyer that they're assuming more risky by purchasing a vehicle because the seller has less liability. Does that answer your question? Is that right?

[Rep. Theresa Wood (Chair)]: Yes, I'm not sure.

[Rep. Bert (first name unknown)]: Don't know exactly where it lands in the realm of healthcare, but that is where it's coming from. It does land in the realm. I'm specifically looking at this specifically for its legal nature in any statute, whether that has to do with healthcare or with selling a car.

[Rep. Esme Cole (Member)]: So trying Yeah, to interpret from the language, so would you envision this being just a form or?

[Rep. Bert (first name unknown)]: I think it would be a very quick statement that says that, I don't know how to work that. It's any high amendment that refers to, let's say, R and D? I don't remember anything.

[Rep. Esme Cole (Member)]: Similar to maybe like a prescription when you get a sheet of paper with package?

[Rep. Zon Eastes (Member)]: Yes.

[Kelsey Stabsef (Executive Director, Northeast Kingdom Human Services)]: Yeah, okay.

[Rep. Bert (first name unknown)]: So just a disclosure of the immunity that's worded regarding what's in statute here, and then the patient would sign that, along with the extra information to deal with potential harms and risks associated.

[Rep. Theresa Wood (Chair)]: I was going to say, I was just going to ask you if you might address that, because it's not just notification of the physician immunity that you're addressing in the amendment. So could you speak a little bit to that?

[Rep. Bert (first name unknown)]: Yeah, so it's basically just, it is looping in Title 18, which we already have, but doing it, making sure it's specifically with regard to immunization and in this instance of recommended immunization. I'm kind of curious as to how, being that this is where it seems like the nature of creating this bill is to provide another framework for creating recommended immunizations separate from federal guidelines. Is that In addition to. In addition to it, okay. So being that it's an addition to the guidelines recommended by the federal government, I just see that it is important to establish both the fact that there's additional immunity that's being added that's not, I'm guessing isn't found elsewhere in our statute, and that therefore there are also recommended immunizations that I think it's also good to have additional language about informing of something in the instance. I'm assuming, and maybe you've had this discussion, I haven't watched any of this textbook, I'm fairly busy, but one question that I have is given that these are additional guidelines, and there's added immunity for healthcare professionals, I'm wondering if a patient were to be harmed by the recommended immunization, will it still go through the same process that all the federally recommended immunizations will go through? Yes. And you try to, I guess, you correct it now?

[Rep. Theresa Wood (Chair)]: Yes, we've got that explanation. That

[Rep. Bert (first name unknown)]: makes me feel much better.

[Rep. Theresa Wood (Chair)]: Yeah, I thought it might. Bishop?

[Rep. Doug Bishop (Member)]: Just getting to this point of the interplay currently, I understand, the federal requirement is to provide the information but it's about the adverse effects, etc, from immunization, but it is not a federal requirement that there be a sign off by the patient for the receipt. And there is already federal liability protections for the providers of immunizations, and this is just continuing that, and again, at the federal level currently there's no requirement that a patient acknowledged shift of liability, so those parts of this bill are really just maintained by the current federal practice, so why do

[Rep. Bert (first name unknown)]: you see any change from that aspect of the current federal practice? I see that the bill inherently is a change from the current federal practice, so I think as a state that it's important to make sure that we're making sure we donorize the most RTs with regard to how we properly like the new patient in this case. I think it's a shifting reallocation of risk onto the patient in addition to other federal government. Currently because the patient is perceiving an immunization that may or

[Rep. Zon Eastes (Member)]: may not be in line with effective guidelines in that time.

[Rep. Bert (first name unknown)]: I think it's also important to do that for the sake of the healthcare professional, the signed document,

[Rep. Zon Eastes (Member)]: in addition to what the patient's getting.

[Rep. Theresa Wood (Chair)]: Okay, all right, thank you, Representative Burt. We appreciate you being here and fitting it into your schedule and everything. So appreciate.

[Rep. Bert (first name unknown)]: Appreciate you, Philip. Thank you.

[Rep. Theresa Wood (Chair)]: Of course. Katie, could you come and just sort of review what we think that we're reading here?

[Rep. Bert (first name unknown)]: Stay in

[Rep. Theresa Wood (Chair)]: the Absolutely, welcome. Have a

[Katie McLinn (Office of Legislative Counsel)]: seat. Okay, that's all good. Okay. The amendment. Katie McBean, Office of Legislative Counsel. So we're in section two of the bill. This is the section of all homegazement language. And subsection C is the immunity from civil and administrative liability. So this subdivision C1 is what is in your bill as just C. And then the new language, this amendment is adding subdivision C2, that prior to prescribing, dispensing or administering a recommended immunization, a healthcare professional shall combine the patient, or if the patient is a minor, the patient's parent or guardian, with written information disclosing all potential harms, risks, and side effects associated with the recommended immunization and provide disclosure of the healthcare professionals and immunity pursuant to subdivision one of this subsection. So they're disclosing the fact that they have this Vermont specific immunity and they're also disclosing any harm's risk side effects associated with the recommended immunization that's being provided. Prior to administering the recommended immunization, the healthcare professional shall obtain written acknowledgement of receipt of the information required pursuant to this subdivision of the patient or if the patient is a minor than the patient's parent or guardian. So sort of a new step in the provision of recommended immunizations is after having that conversation or providing that information that the healthcare professional would have to collect a signature that in fact they have disclosed about the Vermont specific immunity and any risks, side effects, harms, potential harms associated with the recommended immunization.

[Rep. Eric Maguire (Member)]: Yeah, go ahead. Just help me out for one second because it seemed like things were getting complicated. So more or less this amendment, it's really doing is just help ensure that patients and people are receiving clear information about the potential risks and they're receiving that information and just acknowledging that they're receiving that information in a nutshell.

[Katie McLinn (Office of Legislative Counsel)]: This is saying that there's two pieces of information that have to be provided prior to the administration and that there has to be a signature acknowledging that that information has been delivered to them.

[Rep. Eric Maguire (Member)]: So it's not restricting any access to any immunizations, it's not interfering in any way, shape or form with any clinical judgment already being provided. It's strictly, I go in and I'm looking to get an immunization. The provider says to me, Hey, I wanna give you the information on the risks and potential side effects of this. Could you sign this waiver acknowledging that you've received that information?

[Katie McLinn (Office of Legislative Counsel)]: The person would still be allowed to receive a recommended immunization if their provider is, if it's appropriate for the patient to be receiving it and the patient wants to receive it, yes, the provider would have to give this information first and then collect a signature.

[Rep. Bert (first name unknown)]: Thank you.

[Katie McLinn (Office of Legislative Counsel)]: Do you have a question,

[Rep. Zon Eastes (Member)]: Reverend Lawrence? Possibly.

[Rep. Theresa Wood (Chair)]: Katie, are there provisions for informed consent or consent in that exists in statute already?

[Katie McLinn (Office of Legislative Counsel)]: Oh, let me pull up the statute. Right now, under federal law, there's an information packet that's given out to somebody before they receive an immunization that has the different health effects. Let me see. You have it. Okay, let me stop sharing and

[Rep. Theresa Wood (Chair)]: While Katie's doing that, I just want to let our next witnesses know. We're probably going to take a short break in between, if that's okay. So you can plan your stand up time or you can get another cup of coffee. Okay. And just want so people know the process. We're not gonna be voting on this right away because we have a witness from house judiciary, but he's not able to make it here right now. So we're there's going to be we'll we'll vote on it before we get to the floor this afternoon, but we won't be voting on it right away, just so you know. The original question was the current statutes on consent. You can unfold that chair that's there if you want to.

[Denise Walton (Community member, Concord; Sid's Pantry advocate)]: Okay.

[Rep. Theresa Wood (Chair)]: Katie, it's something you can also come back.

[Rep. Esme Cole (Member)]: Okay. Have my fingertips. No,

[Rep. Theresa Wood (Chair)]: that's what I And like I said, we're gonna because we have other witnesses and we have other witnesses on this bill as well. I mean, this amendment will we can come back to that question. Okay. Or the answer to that question. Okay. Anne Bales have any other questions for Katie right at this moment?

[Rep. Zon Eastes (Member)]: I do.

[Rep. Theresa Wood (Chair)]: Yes, go ahead, Representative Eastes.

[Rep. Zon Eastes (Member)]: The crux here is, I mean, I'm reading about conformed consent and how that works in your state. It seems like the crux of this amendment is getting a signature. That's the issue.

[Katie McLinn (Office of Legislative Counsel)]: It's sorry.

[Rep. Theresa Wood (Chair)]: Didn't mean

[Rep. Eric Maguire (Member)]: to interrupt No. It's all

[Rep. Zon Eastes (Member)]: about if that if that's already in statute somewhere, if there's a provision for that.

[Katie McLinn (Office of Legislative Counsel)]: I would say that it's not just getting a signature. I feel like it's twofold because it is having a conversation about this immunity provision, which is not currently required. So it's not just the signature, it's having the conversation about any adverse effects and the language about immunity in statute and then getting the signature. So I wanna be clear that it's not just a signature, it's additional information that will be part of the conversation prior to standing and immunization.

[Rep. Theresa Wood (Chair)]: I'm just gonna ask, is, okay, I'm not gonna ask that. Go ahead, Representative Maguire.

[Rep. Eric Maguire (Member)]: I see, okay, I see now. Yeah, so literally this thing is requiring and mandatorily requiring the individuals receiving the information, they must sign the floor. Is that what I'm also okay. Yes. Alright.

[Rep. Daniel Noyes (Clerk)]: Go ahead, Rep. Sam Noyes. And does this, do they have to understand it or can they come back to the medical professional after and say, I didn't really understand what I was signing? And could that have an impact on their insurance or whatever? Mean, does it open for more? Do they have to under

[Rep. Anne B. Donahue (Ranking Member)]: Yeah, not under this.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: They have to the language

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: is obtained written acknowledgment of receipt. So that isn't a statement of understanding. It's a statement of the information has been provided to them.

[Rep. Theresa Wood (Chair)]: So they don't have to understand it. We're going to have one more question for Katie, and then we're going to move to general counsel for the Department of Health to who is.

[Rep. Eric Maguire (Member)]: I have more of a statement, but that can wait till the

[Rep. Anne B. Donahue (Ranking Member)]: council's Okay, we're going to

[Rep. Theresa Wood (Chair)]: have more discussion. So any other questions for Katie? Thank you so much for popping in, Katie. Know you've got lots of things on your schedule. And now Lauren Lamoille is going to join us. I just said it, but just remind people who you are. Absolutely, thank you.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: I'm Lauren Lehnich, I'm the General Counsel for the Department of Health. Thank you all for having me here today. Helpful conversation. So I want to take a step back to the liability detection and remind us that it is the right amount. So it is just for gross negligence or any adverse reactions to the vaccines that are administered exactly in accordance with the recommendations from the law. So because that's so narrow, it's actually narrower than what is on the federal level at this time. The federal level right now, any recommended vaccine, any vaccine injuries, they're capped at any of your damages at $1,000 in civil court. Anything above $1,000 in damages, you need to go to the Vaccine Injury Compensation Program at the national level. That protects both providers and drug manufacturers from liability. Gross negligence, negligence, protection. That is not the case here. We can't recreate that on the state level. We have narrowed it. So the shifting of risk is actually more toward the provider here and not toward the patient. Because the risk liability protection is narrower for the provider. It is just for gross negligence and just for injuries related to the administration of the vaccine or prescribing a vaccine or dispensing a vaccine in accordance with the state recommendations. If there's discrepancy between state and federal, as you've all seen in this bill, there's going to be a lot of back and forth with experts in the state, experts on the national level about vaccine science, about evidence based and scientifically sound recommendations. So to the extent they're inconsistent with the federal level, and the federal level recommendations will also inform the state level recommendations. To the extent that they're inconsistent, that science will be available and it'll be a scientifically sound recommendation. Right now, the federal liability protections have not changed. So right now, even if the state comes out with new recommendations, the ICP, liability, would provide fraud or liability protection than the state law.

[Rep. Theresa Wood (Chair)]: So I want to be clear, one of the previous witnesses, the sponsor of the amendment, really was trying to have protections for patients with the belief that this was creating more risk for the patient. So I personally don't see that, but interested I in your opinion about whether or not this creates more risk for the patient.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: I disagree with that statement because right now, the national program provides much broader liability protection for providers and pharmaceutical manufacturers should a vaccine not be included in that national program is very near. This is just to a provider followed state recommendations, scientists have evidence based state recommendations, and that very rare one in a million chance somebody had an adverse event happen from the right dosage, recommended dosage, the recommended schedule, the recommended vaccine, and then that the provider themselves is not gonna be held liable for doing exactly what the state recommended and what the science recommended and what evidence base is out there. So that's actually much narrower and the shift is to more liability for the provider and for the patient.

[Rep. Theresa Wood (Chair)]: Other questions for Ms. Lamoille? Yes, go ahead.

[Rep. Eric Maguire (Member)]: So what you're saying, the amendment as laid on out, and again, reading the amendment, it's asking that the provider buy to the patient, parents clear information in regards to potential risks and side effects of the vaccine, disclosing that information and then requiring the patient to mandatory which I didn't go away from them, sign off that they received that information.

[Rep. Esme Cole (Member)]: Thank you. And so

[Rep. Eric Maguire (Member)]: therefore, I'm kind of losing track to where we're talking about like, okay, all of these liability risks and I'm trying to bring it back around to get clear understanding in which is being requested with the information and that being here's the information if you were to sign off on this consent.

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: Yeah absolutely and they do and I agree there's two components here. One of that liability disclosure and then there's the potential risk side effects and harms. And I'm going to nerd out on one word, potential. Because right now under current law it's 12 VSA nineteen oh nine providers, healthcare providers in Vermont are subject to malpractice, medical malpractice if they don't disclose the foreseeable risks, harms and side effects of a treatment or procedure. So, and that would not be protected under this liability protection because that's not an injury in accordance from that routine schedule. That if a provider failed to provide that informed consent to a patient under current law with no changes, the foreseeable risks, etcetera, then they could be subject to malpractice insurance battery under the law or malpractice liability is considered battery. So that is current law. The risk with the potential harms is that term is broad in me. And so if I'm a lawyer, if I'm a physician, I'm assuming real risk there and it creates barriers to access when physicians are afraid because what if there's some unknown potential risk out there that they don't know about yet, it hasn't been published in the literature, and they fail to disclose that. Also, there's a lot of associated but not caused adverse events or incidents or side effects. Somebody might get sick three days later and it's not related to the vaccine, but they can report that to the adverse event system. They can say, Hey, it is not verified. There's no verification requirement. So then, is that a potential risk, harm, or side effect that they have disclosed? And if they do that, that can create unwarranted fear and misinformation in that immunization space. So we don't we don't have specific informed consent requirements for much riskier medical procedures and treatments out there. And there's been a regular choice to really rely on the language in '12 and BSA 1909 to say your obligation as a provider is to know what the foreseeable risks are. Foreseeable, you've heard about it, it's known, it's verified, to disclose those to your patient and not only that, but to do so in a way that the patient understands. So there's an environment that you do so in a way that makes that patient understand. So our concern with adding traditional language is not only that it's vague and broad, but that it will create barriers to access and it will create barriers to increased fusion and incorrect information out there that's not verified. We'd rather let them be system off.

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: Thank you. Just

[Rep. Theresa Wood (Chair)]: a second. So just as an FYI, Katie found the information that I was asking about, and she'll summarize that for us when we're done so you can understand a little bit better what exactly the state law currently says. Okay. Go ahead, Bishop.

[Rep. Zon Eastes (Member)]: If this amendment were to pass, the bill was to pass, and doctors were required, or providers who are given immunizations were required to disclose the liability aspect of this, the shifting liability as it's referred to by the bill sponsor, and the patient asks questions. Do you feel that the practitioners giving immunizations are well suited to provide legal advice on what the liability means?

[Lauren Lehnich (General Counsel, Vermont Department of Health)]: Maybe there's some doctor lawyers out there. Yeah, I would imagine that they were just No, I don't know. That's a good question. It's obviously the worst. Okay,

[Rep. Theresa Wood (Chair)]: Thank you. Any other questions for Lauren? Okay. So what we're going to do now Katie had to go to Ways and Means, this bill. They're doing a drive by. It's a very popular bill in the building. So Laurie is posting the section of law that Katie found for us, you can read it for yourself. But then Katie is going come back and provide a summary of that for us when she's done in Ways and Means. So what we're going to do right now is to take a if we could come back slightly less than fifteen minute break, like twenty five of, that would

[Carrie Stahler (Senior Manager of Government Affairs, Vermont Foodbank)]: be great.

[Rep. Theresa Wood (Chair)]: And thank you for being