Vermont Legislature SmartTranscripts:

[Rep. Theresa Wood (Chair)]: Okay, good morning, folks. Welcome back after the break to the Cross Human Services. I need to put my glasses on so I can see what I'm doing. Otherwise, can work. Okay. So this morning, we are taking up Representative Burt's amendment to H545, an act relating to issuing immunization recommendations. And we're going have a walk through of the amendment from Legis Council. So Katie, welcome to the oh, we have a fancy chair at the end now. Nice. I don't know. You got wheels and everything now. See? Don't tell anybody.

[Rep. Doug Bishop]: I shouldn't look too closely at the committee rooms.

[Rep. Theresa Wood (Chair)]: Idea have where it came from or how it arrived there. So it wasn't me. So thank you, Katie. Floor is yours.

[Katie McLain, Legislative Counsel]: Thank you. Katie McBride, Office

[Katie McLain, Legislative Counsel]: of Legislative Counsel. Let me

[Rep. Esme Cole]: just make sure I'm pulling up the right document.

[Rep. Theresa Wood (Chair)]: And folks, we have this on our website. Okay.

[Katie McLain, Legislative Counsel]: So a week ago when we last met, we looked at the Senate proposal amendment.

[Katie McLain, Legislative Counsel]: Did I say Katie McLean, office

[Katie McLain, Legislative Counsel]: of legislative council? Asking. Yes. I did. Okay. When I was here a week

[Rep. Esme Cole]: or so ago, we looked

[Katie McLain, Legislative Counsel]: at the senate proposal of amendment that came back. This is an amendment to that senate proposal of amendment. What is happening here is we are striking out a section c of the senate proposal of amendment and putting a new subsection c in. Right now, on the screen, what we're looking at, c one, is what is currently subsection c in the bill. So this we're just adding a a new subdivision to c. And so the new language is all contained in c two.

[Rep. Theresa Wood (Chair)]: Katie, can I ask you also to pull up the Senate amendment so people can actually see what Do you want to start there first? I think that just to refresh people's memories, it's been a week and you know. Yep, I have it up. Thank you.

[Katie McLain, Legislative Counsel]: So this is a Senate proposal amendment, and the language that you're looking at is in section two. So this is a section on recommended immunizations. To refresh your memory, this is the section that authorizes and provides guardrails around what the commissioner can provide recommendations specifically on with regard to immunizations. We have language in B about who the commissioner is consulting with and what recommendations the commissioner is considering. And then this is the subsection C that would be replaced by this proposal.

[Rep. Theresa Wood (Chair)]: Replaced or it proceeds? Because this is called C1.

[Katie McLain, Legislative Counsel]: So this C would come out of the draft. Okay. And then C1 and two would go into the draft.

[Rep. Theresa Wood (Chair)]: Gotcha. Okay. Alright. So let's just

[Katie McLain, Legislative Counsel]: okay. So you're gonna tell us what the differences are? Yep. So this language in c that's on your screen, this would be retained as c one, And the amendment adds as Okay.

[Rep. Theresa Wood (Chair)]: Got it now.

[Katie McLain, Legislative Counsel]: Okay. Thank you. No problem. Now

[Rep. Theresa Wood (Chair)]: we can go back to the-

[Katie McLain, Legislative Counsel]: Switch back to the other document. Thank you.

[Rep. Greg Burt]: Okay. So we'll just look at c two because that's where the change is. It would add this paragraph that says, prior to administering a recommended immunization, a health care professional shall provide the patient, or if the patient is a minor, the patient's parent or guardian, with written information disclosing potential harms, risks, and side effects associated with the recommended immunization. The healthcare professional shall obtain written acknowledgement of receipt of the information required by this subdivision from the patient or the patient is a minor from the patient's parent or guardian. So this is requiring that prior to administering an immunization, the patient or the

[Katie McLain, Legislative Counsel]: parent receives information about the side effects, risks, potential harms associated with the recommended immunization. And once that information has been provided, the healthcare professional obtains a written acknowledgement that that information has been

[Rep. Theresa Wood (Chair)]: passed to the patient or to the parent. Thank you. So one thing I noticed when comparing the previous amendment to this amendment is where the new one says prior to administering. The old one said prior to prescribing, dispensing or administering. Yep, that's one difference. Okay, so I'm just pointing these out for folks. And let me know if I didn't get them all, Katie. Okay. Other place, a couple other places where on line 15, where it says written information disclosing potential harms, It used to say disclosing all potential harms in the old amendment. And then right after that, after where it says there's a period now that says recommended immunization. And in the previous amendment that we previously considered and provide disclosure of the health care professionals immunity pursuant to subdivision one of this subsection. And then right after that, the beginning of the sentence that now reads, Just the healthcare professional. It used to say, Prior to administering the recommended immunization, the healthcare professional. Did I get them all? You got them

[Rep. Anne B. Donahue (Ranking Member)]: all. Okay.

[Rep. Theresa Wood (Chair)]: Anybody have any questions for Katie on what the language Okay. Thank you, Katie. Appreciate it. Okay, represent Bert. Welcome back.

[Rep. Greg Burt]: Thanks for having me again. Of course.

[Rep. Theresa Wood (Chair)]: Good morning. Good morning.

[Rep. Greg Burt]: For the record, Greg Burt, representatives. Yeah, I'm back again, and as you did a great job of pointing out the differences between this amendment and the previous one, and I did listen to concerns from the last time we met, particularly about the liability part, and we took that out. Let me get started here. So I wanna first say I was gonna go over the differences and and that's already been done, I don't need to do that. But First of all, I think there's precedent for having written informed consent. When you go to get a vaccine as it is right now, there's already documentation that has to be done that surrounds the process, reporting what the vaccine is and who it was administered to. There's already documentation that's done for every visit anyway. There are also already opioid treatments where a written informed consent is already required, and with some Lyme disease treatments that I'm aware of in the state of Vermont, there is written informed consent already required. So it's something that is already done. It's not new. Would be scaling up the degree and the amount of paperwork that would need to be done. I don't know about you, but just going to the dentist's office, I feel like I get seven forms I have to fill out every time I go in before I go in to get a cleaning. I'm not a fan of paperwork either. I think it's small steps that is an important one, And I'll go over that more. I think a good example actually happened to my own family this last couple of weeks. My wife went in to get the hep B shot for my youngest daughter, and they asked if it was okay if the nurse could administer it, and my wife said, Sure, that's fine. She sat down, the nurse came in, and there wasn't a conversation, there wasn't a question asked, Would you like me to talk about the vaccine or the benefits or the risks of the vaccine? And it was a bit rushed and maybe things were just hectic that morning, but my wife even had to ask the nurse like, okay, do you have the right vaccine? I wanna make sure, you know, before we start, did you have the right one? So she checked back with someone else and came back and sure enough, she had the right one, but my it quite rushed and my wife was concerned. I wanted to make sure, okay, let's make sure we're at least administering the right thing to my daughter here. And she'd already done all the research and was confident in what she was doing, so she didn't need to have that conversation, she didn't request it, but it wasn't part of the process. The nurse didn't ask my wife, Would you like to talk about this before we go ahead? Also, knowing that we have the right vaccine that's being administered. So I think that example alone to me is enough to say it's a good idea to have a framework to make sure that I would assume that when they have a conversation about the benefits and risks of a vaccine that they are confident that they're administering the right one, the one that the mother came in and her father to have administer to their child. And then it does open up opportunity to have that conversation that I think is very important. I know that it sounds to me like from what I've heard the main goal with this program is increasing access, and I understand that that's an important goal to have in place. And we don't want to inhibit access. Having this conversation, I think there's a little bit of fear that between the paperwork and between outlining the potential risks or harms of the vaccine might push some people away from having their child or themselves vaccinated. I think that's an important conversation and an important thing to go over, But I want to give an example briefly, if you don't mind me asking or giving an example. I have an apple orchard, as some of you know, with about 12,000 trees. I didn't start off as an apple farmer. My dad never did anything with apples, so was a whole new endeavor. I had to learn it all on my own. I went and did a ton of research because I'd never even grown a tree, let alone an apple tree. Cornell University came to the top of the list for an institution that had a lot of information that was going to be helpful for me. They're pretty much the premier institution for orcharding and palmology in the Northeast. And so they were recommending doing a system called tall spindle, which is a high density planting of apple trees. It gives you a lot higher yields and it's and it's relatively easy to grow that system. Their main goal was to have them to maximize production per acre and to and and do so with the least amount of input costs. So they had a couple variables and but the main goal was essentially to maximize production per acre. Eight years in, I started to see where that goal didn't create the best outcomes. Narrowness

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: of

[Rep. Greg Burt]: the rows made it difficult for my workers to get around safely and do work around, you know, picking and and equipment. The narrowness of the rows made it so that I would create ruts in the orchard in a wet year, and the ruts would create erosion and soil compaction. So I had to institute all these things that were really expensive to undo the problems that came with trying to make so many apples per acre. In hindsight, had I known, I would have said, my goal needs to be business profitability and business management, overall orchard health, not production per acre. I want to provide it as an example of institutions can sometimes set goals that I don't think quite align with what the goal needs to be at the end of the day. And I hate to say that, but I definitely saw that firsthand with what I saw with my own orchard, and I've had to undo the mistakes from and with an orchard, it's years of you know, you're you're looking at a thirty to forty year investment. It's not something that's like pop up a business and help you make some money and then, you know, go on to something else. I don't think the overall goal should be access with this bill. The overall goal should be overall community health. That conversation that's had in the doctor's office, I think, is one that is fragile in nature, but is essential. And I want to bring up our state motto, which is freedom and unity, and I think it is such a beautiful motto because it does encapsulate what it looks like to live together as a people of the state of Vermont. People come to get immunized on their own volition. And if our goal is overall community health, which is going to include rate of vaccination and access, It has to be coupled with making sure that those parents that bring in their children or themselves to be vaccinated are given all the information that they should be given about the risks because as much as it is about their own health, we all know that we're asking people to do this for everyone's sake. That's where the unity part comes in. My wife brought in our daughter for a hep B shot, not just for my daughter, but because we know that we need to do it for everyone else's kids. But if my daughter were to be harmed by that, I'd at least want to know that we knew all the risks going into it, and have that consolation that it was our decision that we volunteered ourselves for that. But if my wife went in and hadn't done the research and hadn't been told about the risks and our daughter got injured in the process, I would be irate at the system myself for not being told, Hey, this can happen. This is a real thing. It might only be one in a million or whatever it is, but it's still a risk and it still needs to be addressed. If we're looking at overall community health, that is a really important conversation. Because if you don't have that, if it is one in a million even, and the circle of people that surrounds us, there's a good chance that someone is going to know someone who is harmed eventually, I'm really afraid of the breakdown of trust over time. That can and I think is happening, because I think there used to be a stronger sense of folks voluntarily being willing to put themselves out there for the sake of the community, that's not there as much anymore. I don't want to get too sidetracked on my thinking, but that conversation about the risks involved is really important to solidifying that trust, acknowledging people's freedom, and helping that to create the unity. That to me is going to generate overall community health. If we ignore that and we solely look at access and we sacrifice those conversations about risk for the sake of access, we're over time going to hurt our community health. So I think you got to couple the two together and this amendment, I think does that appropriately. I don't think it's over the top to ask for a piece of paper that makes sure that people got that information. I would have loved to have had that for the sake of my wife. I'm glad that she is informed on her own, but I don't want to see that happen to other folks. I think that's all I have.

[Rep. Esme Cole]: Thank you, Burke.

[Rep. Greg Burt]: I was gonna ask if I could if after someone else spoke, if I would be given the opportunity for rebuttal. No. This is your

[Rep. Theresa Wood (Chair)]: opportunity to speak to the committee here.

[Rep. Greg Burt]: I appreciate it. Thank you.

[Rep. Theresa Wood (Chair)]: But let me just see if anybody has any questions. Yeah, go ahead, Representative Bishop.

[Rep. Doug Bishop]: Thank you for coming back to the committee this morning. We've received emails from folks who have opinions to share on both sides of the issue related to your amendment. And some of that information includes reference to the federal requirements of providing information, the vaccine information statements required, it was shared with us to be given, and there are state laws already in place regarding informed consent. Can you share with me your thinking on why approach it through amendment with new requirements rather than enforcement on existing requirements? Sure.

[Rep. Greg Burt]: Well, so it's really just adding the requirement that there's written receipt that it happened, right? And like I said earlier, that already takes place with Lyme disease treatments and certain opioid treatments. So we do that already. Somebody decided at some point that that was important to do for those things. I think it's important to do for this. So I think the informed consent that's in title eighteen and twelve, it doesn't go far enough in my mind to make sure that that information actually is given. Does that answer all

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: your questions or is there another one in there?

[Rep. Theresa Wood (Chair)]: Can I just ask? That was actually a question I was going to ask as well. Representative Baer, I don't actually think you did answer the question. So the question was, why is your approach this versus amending existing statute to require written consent?

[Rep. Greg Burt]: For every treatment or specifically for immunization?

[Rep. Theresa Wood (Chair)]: I will say I'm having a hard time conflating opioid treatment, which we know is highly addictive substance to immunizations for vaccines for certain diseases. It's not the same thing.

[Rep. Greg Burt]: Sure, I'm not trying to compare them in terms of the treatments themselves. I'm just trying to make the point that

[Rep. Theresa Wood (Chair)]: In some cases-

[Rep. Greg Burt]: But in receipt is required for other

[Rep. Theresa Wood (Chair)]: Yeah, I think that's based upon the knowledge that we have, particularly now about the addictive qualities of Yes,

[Rep. Greg Burt]: understood, yes. I think the Lyme disease treatment-

[Rep. Theresa Wood (Chair)]: I don't know as much about this.

[Rep. Greg Burt]: Maybe a little bit better example in terms of aligning a little bit closer. But I mean and in terms of just written receipt, I mean I mean, I I when I go to Tractor Supply as a farmer, you know, I have to sign that I'm, you know, immune from sales tax for, you know, purchasing a $10 item. I mean, they have and it's fast and they report it and it's it's not a big deal. So I feel like if they can do it, it's it's quite easy to do if there's a system in place. It would just prevent things like what happened to my wife two weeks ago. And I don't know how often that happens, but I was surprised when it when it happened to ourselves. So Thank you. Other questions for this witness?

[Rep. Theresa Wood (Chair)]: Thank you, representative Bert. Thanks. Thanks. Okay. The I what I'd asked Laurie to do was to pull up the previous testimony we had from witnesses on this topic, just to try to honestly be succinct. Some of that information is going to be with regard to the pieces that are now withdrawn. But would people find that helpful? It was from January 22, I think, January 22. Would people find that helpful? Or we also have representatives from the health department and the physicians here as well. I'm warranted on schedule for testimony, but I'm sure that he'd be more than happy to get in the witness here.

[Rep. Anne B. Donahue (Ranking Member)]: I wanted mean, to make one comment where think it's not about testimony, it's about a misunderstanding of what the bill, the kind of repeated reference to the point of the bill is about increasing access. And I don't think that was the point of the bill. The point of the bill was retaining the same degree of access, not allowing it to be reduced. I didn't hear anything in any testimony at any time about increasing access.

[Katie McLain, Legislative Counsel]: That's correct. To keep what we have,

[Rep. Anne B. Donahue (Ranking Member)]: just to clarify that, yeah.

[Unidentified Committee Member]: I have just very basic technical question. I don't understand. Let's say that we were to recommend adoption of this particular amendment, does it then have to go back to the senate? Do we have the capacity to adopt an amendment?

[Rep. Theresa Wood (Chair)]: No. It will go back to the senate.

[Rep. Eric Maguire]: So the process has now slowed down.

[Rep. Theresa Wood (Chair)]: Yeah. That think, you know, if if it's if people are supportive of the amendment, then we do whatever the process calls for. Just need to understand. Yes. That is we would if if we voted to amend and the body supported the amendment, then it would go back to the senate with proposal of further amendment. They would vote on it. They would go back to the Senate Health and Welfare Committee. They would vote on it. They would bring it back to the floor. They would send it back. Okay. Yes. Go ahead, representative Steady. That could be a question. Esme? No, Anne just making a statement. You can make a statement.

[Rep. Esme Cole]: I just have to ask because I We don't have a witness in

[Rep. Theresa Wood (Chair)]: the chair. It's a committee discussion.

[Katie McLain, Legislative Counsel]: I agree with this amendment. If my kids were, I never had anybody tell me anything. I just stopped. You had to do the shots. As a grandma, I would want my son informed of immunizations and this would just be one more step to protect the child. That my input. Thank you. Go ahead, Cole. Yeah, I think in response,

[Rep. Esme Cole]: I'm concerned that this could turn into something like, oh, well, we're having this conversation in order it's almost transactional. We're having this conversation about consent in order for me to get your signature, which makes it seem as though the doctor is trying to impose a vaccine on you, rather than the trust that could be developed by actually having a candid conversation with your doctor and nothing's on the line and you step away at any moment from having that vaccine. Of course, there's no mandate. I'm worried that the nature of that conversation and trust levels could be diminished from getting what For example, I don't know that this could happen, but maybe the patient could think that the doctor was not being honest because they wanted to get the person's signature versus understanding that the person could ask any question they want and then just not get the vaccine if they didn't want to get the vaccine. That's kind

[Katie McLain, Legislative Counsel]: of our skin. Go ahead, Representative Maguire.

[Rep. Eric Maguire]: I appreciate that. I actually support this amendment because I I feel it does strengthen informed consent while preserving access to recommended immunizations. I think it provides a a clear and reasonable liability protection for for the providers and acts within the accepted medical standards. And I think also that together these updates actually enhance transparency, patient trust, and also responsible public health practices. So I'm in support at this time of this event. Thank you.

[Rep. Anne B. Donahue (Ranking Member)]: Okay, go ahead. So I just want to, I mean, I think there's a broader issue if there's concern about our physician community not doing a good job of informed consent about all sorts of things, including much higher risk drugs and so forth. That's an issue could be a valid issue to bring to this committee and look at. In this particular case, I always think of informed consent as the concept of a balanced, your physician is expected to give you a balanced view. And I don't think the state should be weighing in on that and making one thing different and saying, Well, we think for this one, need written saying in writing that I accepted it. You're communicating that the state's saying there's something different and scary about this. That's not an even balanced perspective. We're imposing a viewpoint on it. I don't see a need or a reason to do that. I think if there isn't good intent process, that's a

[Rep. Theresa Wood (Chair)]: whole other question that applies to everything. So we do have Stephanie Winters from the Medical Society here. I'm going to ask her if you can totally refuse this because didn't give you any advance warning, because I would like to ask a question about that process in which is different. Do you accept the invitation, Stephanie? I'm sitting in the red chair now.

[Stephanie Winters (Deputy Director, Vermont Medical Society)]: I can directly accept the invitation. Stephanie McGill is Deputy Director of the Vermont Medical Society. I'm also the Executive Director for the American Academy of Pediatrics Vermont Chapter and the Vermont Academy of Family Physicians. Thank you. So the previous witness raised

[Rep. Theresa Wood (Chair)]: the issue of the obligation of health care professionals to provide information at the time of a a know the law, the Title 12 law around consent. What is the process that either the medical society does in terms of ongoing education or reminders? Or how would somebody, a patient, a guardian, a parent either file a complaint about that? Or how is that addressed when people don't appear to be following the law? I also note in that law, though, that in that reading of that statute, that if the patient arrives requesting a certain treatment, that there are provisions further down in that address that as well. And so I think it's not sort of a simple cut and dry when I look at Title XII of, You must do this. So I'm gonna let you speak about it. You're much more informed about it than I do.

[Stephanie Winters (Deputy Director, Vermont Medical Society)]: Well, and again, I just wanna The caveat, I'm not in a clinical setting, I'm not a clinician, so I just represent them. But I would say you guys have had a great conversation here and have hit a number of the points. And I think just listening to Representative Burt, the conversation is different, depending on your, as a patient, your request for a vaccine, or if you have questions. Obviously, we are all our own best advocates, but federal law does require the vaccine information sheet that goes over all of the most common risks, benefits to the vaccine, and then your practitioner asks if you have questions. If you don't, you're well informed, then that may end the conversation about that. They give you the vaccine and you leave. If you have a question or you have more of a conversation or it's part of a broader appointment where you may not have come in for that vaccine, but I was in the other day for my well visit, and they asked if I wanted my COVID and flu, or if I'd had my COVID and flu vaccines. And we had a conversation about that, and the timing, and if it was worth it. And then I made that decision with my practitioner. And so I think the conversation is one that's free flowing and should allow for that kind of conversation and discussion. If a patient or a caregiver does not feel like that conversation has happened, and they don't think the appropriate informed consent was given, they should contact the board of medical practice. Or I I would say they should have a conversation with their practitioner office and say, I really feel like I didn't get that informed consent. Why? I don't feel like my questions were answered. How can we help that? If things are not resolved, there is a process through the licensing agencies. So for MDs and PAs, it's through the Board of Medical Practice, for APRNs and DOs, Doctors of Osteopathic Medicine, through the Office of Professional Regulation. So there are venues if you don't feel like you're getting that adequately. What I will say is one, it's federal law. Two, informed consent is written into our Vermont statute, not specifically calling out vaccines, but informed consent for healthcare. So it is written into it. It's also in the ethical guidelines for practicing medicine. And again, informed consent is a different conversation for each patient because every patient is individual and has different needs, different questions, different concerns. So I would just say that we would be concerned about this amendment. I think, one, anytime you have a sign off, it amplifies hesitancy as representative Donahue talked about calling this out as something riskier than anything else. The informed consent for opioid, I think as representative Wood noted is very different. And for Lyme disease, that is also a controversial topic. That is informed consent. It is not signed informed consent in Vermont law. It is just informed consent. But there is medical controversy over long term chronic Lyme treatment, and there are differing opinions, and that is why the Vermont legislature decided to put that informed consent in. Because there were people who felt like they were not being treated for their long term or chronic Lyme, and some in the medical community feeling like the treatments that were out there were not science based. So that is why that's in there, and that is very different as well. And then I would also call out, and I did send you all an email, but the administrative burden that this would put on a practice, while also hurting the public health of our community members. So that is where we would ask you not to support this amendment and happy to answer further questions. Excuse me. Thank you, Stephanie. Questions from committee members?

[Rep. Theresa Wood (Chair)]: Yes. Go ahead, Rebecca.

[Katie McLain, Legislative Counsel]: So I'm reading your email you sent out yesterday, and there's a lot more to it for transparency. There's more than just you not wanting it. Think that it's important that people be informed. And I was quite concerned with your email yesterday. Thank you.

[Rep. Theresa Wood (Chair)]: Any other questions?

[Rep. Anne B. Donahue (Ranking Member)]: Okay. Thank you. Thank you, Stephanie.

[Rep. Theresa Wood (Chair)]: Okay. Are people ready to vote on the amendment?

[Katie McLain, Legislative Counsel]: I

[Rep. Theresa Wood (Chair)]: would entertain a motion to find the how did we do it last time, Dan? No?

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: I would make a motion to find it unfavorable.

[Rep. Theresa Wood (Chair)]: Unfavorable. Okay. Rep Sam Noyes made a motion to find it unfavorable. So if you vote yes, Oh, yeah. Now I remember this because I provided the same explanation last time. If you vote yes, you are not approving the amendment. If you vote no, you are voting to approve the amendment. Everybody clear on what yes and no means? The opposite in this case? Okay. Alright. Thank you. Any further discussion? Okay. The clerk should call the roll, please.

[Rep. Daniel Noyes (Clerk)]: Representative Bishop? Yes. Representative Cole?

[Rep. Esme Cole]: Yes.

[Rep. Daniel Noyes (Clerk)]: Representative Donahue? Yes. Representative Eastes? Yes. Representative Garofano?

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Yes.

[Rep. Daniel Noyes (Clerk)]: Representative Maguire? No. Representative McGill?

[Rep. Jubilee McGill]: Yes.

[Rep. Daniel Noyes (Clerk)]: Representative Nielsen? Representative Noyes? Yes. Representative Steady? No. Representative Wood? Yes. So 90921.

[Rep. Theresa Wood (Chair)]: No. 98821.

[Rep. Daniel Noyes (Clerk)]: Sorry.

[Rep. Theresa Wood (Chair)]: Math is good.

[Rep. Anne B. Donahue (Ranking Member)]: Good as mine. I'm sorry. No.

[Rep. Theresa Wood (Chair)]: Did not publicly. Okay. Thank you very much, and thank you folks who spoke to this for coming in early this morning. I appreciate that. Okay, we are now going to move on to our

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Sorry, have I'm sorry, more questions.

[Rep. Theresa Wood (Chair)]: If it's procedural, then talk to me at the Okay. Thank you. So we are now going to move on to H657, which is the omnibus DCF bill. And we are going to hear from Tim Lueders Dumont. And we've had back and forth via emails and education about sheriffs, let me tell you. So welcome, Tim. Happy to have you in house human services.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Thank you. Yes. It's good to be back. I think been I wasn't here at all last year, so good to be good to be back. I'm Tim Leaders Gilmour. I'm the executive director of the Department of States Attorneys and Sheriffs. And available to you on your website is a series of of charts about how weird our department is. But, essentially, for those that are unfamiliar

[Rep. Theresa Wood (Chair)]: some of us learned. For

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: those that are unfamiliar, we're essentially a county government pass through for certain services, and then we have centralized certain specialty types of activities at our central office. But we support the 28 county law enforcement officers and law enforcement professionals who are elected in the constitution, state's attorneys and sheriffs. As you can see on your website, I work

[Rep. Theresa Wood (Chair)]: We don't quite have it on our website.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Elected people, so I I

[Rep. Greg Burt]: I

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: empathize with attorney McLint in terms of being an attorney and an executive that is trying to serve a group of elected folks. In terms of the the state's attorney side I'll let you know how it goes.

[Rep. Theresa Wood (Chair)]: Yeah. I I had say through my first year on house corrections and institutions, and then through my work on joint justice oversight, I learned a lot. But I still got an education this week about what happens, what doesn't happen. So I appreciate that. And so members, this is in particular, this testimony is regarding the transport of youth in DCF custody. What we're learning is that there's kind of layers to that. And it's done by several different entities, including elected sheriffs, but also including nonelected sheriffs and private providers, and there's probably more. Thank you.

[Rep. Anne B. Donahue (Ranking Member)]: Posting the chart. Okay. Thank you.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: And and basically, I actually was able to get some of the numbers that we could get. And so most of the work that the transport staff do, there are 25 state employees that work for me, and I allocate them to certain sheriffs. There are certain sheriffs right now that don't have the law enforcement certification. They don't have any of our state employees. Our state employees are only working for certified law enforcement sheriffs, and they work for me. They can be fired, hired, and disciplined by me. But for their law enforcement supervision, we have them situated in local sheriff's departments. We have, 25 FTEs. Story for a different day because of BAA and other things, and OT pressures of the last year. We have four vacancies because we've had to use so much overtime overtime because of the speed up and ramp up of our justice system in the last two years. We had to hold open some positions to pay for overtime, which is a which is a pressure we're facing. Last year, we Are

[Rep. Theresa Wood (Chair)]: they are they are those employee state employees, are they classified as sheriffs? Are they actual sheriffs?

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: They are classified as there's a great Supreme Court decision that decided all of this in Rea elections a number of years ago. They are state employees who are commissioned to be deputy sheriffs, sworn in as deputy sheriffs, but they are state employees that work for our department, actually the central office tech. And we situate them locally. And think about each county sheriff's office as having two sides for the entities that have these state employees. There is the pure county sheriffs, pure deputy county sheriffs. They are no oversight by me, no oversight by central office, just overseen by their local elected chair. Then for those offices, for example, like Washington County, everyone knows sheriff cooling has provided some support here. They've always had transport deputies here. He's a former transport deputy. Those folks are co supervised by myself and the sheriff. Their state employee supervision, their hiring and firing is by me. If there's any union issues or labor issues, it's handled by myself. In terms of him carrying a gun, he or she carrying a gun, their vest, all of that, the local sheriff. And they subsidize the state of Vermont by providing the car, the car insurance, all of that. We pay the salary benefits and all of the HR for those local state transport deputies, but the law enforcement gun carrying level three certification oversight is through the local sheriff. So it's a bit odd. It's very odd, actually. But we do our best to have the the two worlds collide and meet on a lot of overlap in a in a good way. So last year, predominantly, most of what we're doing, criminal transports. To and from facilities, to court hearings, and back. So a minimus gets you back to your facility. A court order gets you from the facility. Those are what we respond to. So whenever a judge puts out a piece of paper saying, this person needs to go to this place, that's what we respond to. Now of the 4,035 transports we did last year by those 25 FTEs, 12 were were juveniles, where a judge said, for example, the Red Clover facility close by to here. We have a juvenile, and I'll say six of them were in Caledonia. Not the twelve, six were in Caledonia. Just gonna put that out there because I think it's very instructive. There is a major drug distribution highway happening through 90 One's Route 7 And 89. And there are young people that are getting sent up to the state of Vermont to engage in this behavior. And they are victims too of what's happened. Folks that are caught up in that situation, unless you're on a list of the unless you're charged as an adult, you will cannot be held in an adult facility. And so when an issue comes up, like selling a regulated drug illegally and you're in St. Johnsbury, you can't be held at a St. Jay facility. We have to figure out custody. If you're not a state of Vermont individual, we have to figure that out. So sometimes those folks temporarily might get held at Red Clover. And if they've been brought to a court and the judge says, we need a place for them to go, that's where we've stepped in and we've done 12 of our 4,035 transports were juvenile orders. The vast majority of movement of juveniles is through a contract. The AHS executes with most of the sheriffs. And so I have zero information about that, which I think is probably the bulk interactions between law enforcement and juveniles in vehicles is probably through that contract. The sheriffs also have a contract with DMH for moving individuals. And if you think about the two categories, if a judge orders it, that's us. If it's through this contract, that's the AHS private contracts with the sheriffs. And so they could provide more information about when restraints are used and the volume as well. And I would really defer to them on that, but I just wanted to tell you most of our resources are criminal court proceedings. And that's really how we're resourced to do things. Under Title 24, any law enforcement officer can be ordered to move prisoners. The word prisoner is used. And any constable as well, which, by the way, I wouldn't advise in a lot of instances, but we could clean that up at some point. So any we so 12 last year. Thus far this fiscal year, 12 as well. So we're outpacing what we did last year for juvenile transports. And again, Caledonia had the most that were ordered from that court, from the family division of that court.

[Rep. Theresa Wood (Chair)]: So I have a question for you. So in your email response, didn't seem as though you kept any data much other than numbers. So would you be able to tell us whether any of those juveniles required restraint of any nature? And if so, what kind?

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: And really talking about the department structure, we pay the bills. And so the reason we keep our data is to track whether or not an official transport took place. We don't have the underlying information or details about why what was going on with that? We would actually have to probably and there isn't that many of these transports, so we could actually do more of an analog. What happened with these 12 transports? Well, look at the docket number. Was was a restraint used? Probably wouldn't be in our data. We would probably have to actually interview the individual transport deputies. And they may actually remember because it wasn't it sticks out. It's unusual. Yeah. Exactly.

[Rep. Theresa Wood (Chair)]: It does.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: And we could engage in a little bit of what were these like? We could find the transport deputies that engaged in these and talk to

[Rep. Theresa Wood (Chair)]: Yeah, I think our overall goal here is to reduce any trauma on youth in this process. It's already a stressful process. And so I guess I would say, don't be surprised if you see yourself appear in this bill. Never a surprise. Representative Bishop, did you have a question?

[Rep. Doug Bishop]: Just wanted to confirm the 12 so far this year. We're talking about state fiscal year. Correct.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: I mean, f y twenty six. Last fiscal full year, f y twenty five, we did 12, and this year, so far, we've got 12. Yeah. I just wanna make sure

[Rep. Doug Bishop]: that wasn't calendar year because that would be

[Rep. Theresa Wood (Chair)]: a Yeah. That's right. Congrats.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: No. Fiscal year. Thank you.

[Rep. Anne B. Donahue (Ranking Member)]: Okay. Representative Donahue and then Noyes. Just to it sounds to me as if that becomes an individual judgment by the sheriff as to what kind of transports needed. Once upon a time, there was sort of a if the sheriff was asked to do it, the assumption is it needs secure shackles, etcetera.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Yeah. So with respect to the court ordered transports Right. A lot has gone, for lack of a better word, a lot's gone wrong probably at that point in terms of the engagement with the system to the point where an official order is someone's already being custodialized in some manner. With, again, probably the vast majority of these interactions being through the contract with DCF, those ones, if we I don't know. I really don't know. And I'll leave it to them. The sheriffs could come in. Mark Anderson, I know you're all familiar with, could talk with you about this. Actually, Sheriff Markku had a very interesting interaction with a young person. It's a confidential matter, but it may be instructive as well offline with folks in terms of the decision tree that happens, when you have a a young person taken in into custody. Because the way our statute works, if you're charging someone with homicide, we're gonna probably start if it's an 18 year old or a 17 year old. We might start by trying to take them to an adult facility because that's an adult crime and and and charge a 17 year old and an 18 year old with an adult crime. If it's a 14 year old for disorderly conduct, but they're really having a tough time and they're now starting to be violent and acting up in a way. Right? My hope would be that there is a lot that happens before a restraint is used on a 14 year old. But I'm sure there are instances where for the safety of the individual and for the law enforcement officers involved. And that's where Chris Raquel, criminal justice counsel, could come in and talk to you about the use of force policy and how the decision tree that happens for that. And, you know, there's been some recent work on that over the last few years, but that instructs, for example, the commissioner of a agency cannot tell a law enforcement officer, you will use force on this person. It has to you will drag them out of their cell. No. It has to be an individualized approach. The law enforcement officer can be decertified for improperly using force, and so that cannot be interrupted, the use of force policy in terms of the individualized officer approach. But what I would presume is that in some of these instances where a violent crime has been alleged, but they're being handled as a youth, a restraint may have taken place. I just don't know the numbers. And we could interview some of the sheriffs about what that that process is like. And we could probably you could sheriff Coolin is always available close by, and I could probably even chat with him later today and give you a little bit more insight. Thank you.

[Rep. Theresa Wood (Chair)]: We have representative Noyes and then back to

[Rep. Daniel Noyes (Clerk)]: Just quickly, and you may have said this and I might have missed it, but do you have data on the age of the transports, those 12 last year and this year?

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: What we would do is look not not record it. We would look in those 12 docket numbers where it was recorded and then look at the date of birth.

[Rep. Daniel Noyes (Clerk)]: No worries. But we could I just was wondering what the what the age was.

[Rep. Theresa Wood (Chair)]: So what we're learning in this process is that we really have a patchwork of systems out there, I loosely call it systems, out there that provide transport for youth in either honestly in DCF custody or youth that might be going to a correctional facility depending upon their age. And it's been pretty difficult for us to get data on how many youth and under what conditions. Essentially, were they restrained in any way or what was some sort of basic data. And we're also wanting to provide some consistency in state statute. So some parts of statute were modified previously, but not all parts. They really, in our view, policy wise, we don't see a difference of needing to have one part of the statute for one group of individuals, youth be different than another group of youth. So we're wanting to fix those kinds of things as well.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: And title 24, two ninety B says basically everything you need to know about why state employees, our state employees that work for me are engaged. And it's a simple sentence, although there is a missing comma, which we'll talk with Katie about, at some point, but it's it's never interrupted actual practice. But full time state transport deputies whose primary responsibility is transportation of prisoners, those are adult prisoners, persons with a mental condition or psychiatric, disability, or juveniles being transported to a court to court or to a court ordered facility. So those that's the that's the universe that we live in, and 90.3 is the juveniles of our numbers last year. So less than 1% of all of our transports were with for juveniles shows the ramp up of our justice system. Actually, in some ways, it might have been a larger percentage in prior years, but we have a lot of adult detainees right now. And every detainee is presumed innocent, and that's our number one priority. I've I've I should mention here, I was I was nearly held in contempt by a by a judge because of my emphasis on prison on prisoners being the emphasis of our program.

[Rep. Theresa Wood (Chair)]: Okay.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: I think everyone needs to be on deck to move people who are being detained, and we have 600 adults being detained right now. So they're all presumed innocent. So any delay for them is inappropriate. And when we are doing civil transports and family division transports where there are different liberty interests, I have always been a proponent of our people with due process rights that are attaching in presumption of innocence are the most important thing. A judge in a civil division in a northern county was very upset with me that I told them that any civil transport for a, let's just say it was a torts case or, a property boundary dispute involving a detainee, that's not a criminal transport, and it's not my priority. We have worked out a plan with the supreme court where that won't happen as much because we're gonna have judge Zonay make those calls instead of me. So I can now officially ask judge Zonay to intervene where there's a conflict, where our resources are limited, and whether it's a family case. Because I think, in my opinion, these 12 juveniles, that's also a really important area for transportation, and it's only less than a percentage. But when we have weight of the evidence hearing for a homicide case and a status conference in a in a merits hearing, where it's they're both important. But a criminal court judge is gonna be very upset if we don't transport that person in a criminal case. And so we we worked on a plan to mitigate conflicts with us and the judiciary because they don't like me telling them that their hearings aren't important. I understand that.

[Rep. Theresa Wood (Chair)]: Other one. Less sports, not the other one. Representative Bishop, did you have another follow-up?

[Rep. Doug Bishop]: I think you may have gotten to it a moment ago in what you said, madam chair, but I'm just trying to get context. So for context, we've got in section nine reference to law enforcement transports under contract with the department, and we've identified this as a potential tool in what we're trying to do. So we're having the conversation.

[Rep. Theresa Wood (Chair)]: Rex and Donahue has been working on multiple drafts of this language, I'm just saying. And I'm not sure if what came out today was the final draft that you landed on or not. I don't they didn't

[Rep. Anne B. Donahue (Ranking Member)]: Well, it's it's it's final pending testimony and wordsmithing and

[Rep. Theresa Wood (Chair)]: all But that's the concept.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: In terms of the bulk of what I presume are the largest volume of movement of young people, you'd wanna maybe put in statute certain data metrics that you'd like to see from the the agency regarding what those look like. And then we could also you can mirror that for us for the smaller number. But if you are transporting a juvenile, and I'll talk with the sheriffs under the state program, please indicate when you notify the central office whether a restraint is used, that sort of thing. And then we can come back with juvenile restraint used, yes, no, something like that.

[Rep. Theresa Wood (Chair)]: Yeah. I think that one of the things that these youth, although they

[Katie McLain, Legislative Counsel]: interesting.

[Rep. Theresa Wood (Chair)]: I think in one level, I was having a thought, I was saying that we've kind of put the onus of responsibility on the Department for Children and Families. But when I think about a 17 or 18 year old, those are not necessarily going to be under DCF jurisdiction.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Well, I will just say, if we were transporting a 17 or 18 year old to or from a facility for an adult crime, that would be counted as an adult transport because we're charging them as an adult, and it would not be counted in that 12.

[Rep. Theresa Wood (Chair)]: In the 12. Correct. So the

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: big 14, everyone aware this used to be a big 12, now it's big 14. Yeah. It's this list of crimes that we can you can charge people who are younger than 18 with adult crimes. And most of them are right or around 18. And then there's sometimes it bounces to the family division, goes opaque, and then sometimes comes back, sometimes doesn't. But the initial transport may have been counted as an adult transport.

[Rep. Theresa Wood (Chair)]: Yeah. That's fair to understand. Any other questions for this witness? Thank you, Tim. Thank you for coming to see you as well.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Always around if you need anything. Always happy to talk about transportation. Thank

[Katie McLain, Legislative Counsel]: you very much.

[Rep. Theresa Wood (Chair)]: Do have from earlier, we

[Rep. Anne B. Donahue (Ranking Member)]: have a breakdown of secure transports for DCF kits, which I can send to

[Rep. Theresa Wood (Chair)]: Lori to post. Yeah, think that would be

[Rep. Esme Cole]: a good idea.

[Rep. Theresa Wood (Chair)]: So the latest version of six fifty seven is just posted this morning. Right, Laurie? That's me. Oh, yes. Sorry. Will be posted. I just gave Laurie permission to do that. And so we will also take that up this afternoon with witnesses this afternoon from the youth side of youth services and advocacy. I So just want to review the schedule of what we're anticipating this week. I know you can all read it, but on the pre K, you'll see we're taking a lot of testimony on pre K. We are going to be downstairs, right, Lori, in Room 10 tomorrow afternoon for pre K, because it's also early childhood day in the legislature. So I was told that it might be a good idea to move us to a little bit larger room because it'd probably be a lot of people in attendance at that hearing. So on the good news side, we have a little bit of extra time. We can take a few days next week in order to sort of finalize whatever we end up doing on pre K because the education, sort of the big education bill, this pre K stuff is going go into the big education bill. And so they have had discussions with the Senate and the House and given us a little bit of extra time on the education bill. So that's good news for us because that means we just have six fifty seven as well as our homelessness bill to get out. So there will be a new draft of the homelessness bill. I don't know. Katie is working on it. So I can't tell you exactly when it'll be available, hopefully by tomorrow morning. And in the meantime, because of the time issues, I've asked Eric and Jubilee to sit with me and to go through all of the feedback that we've received in writing from everybody around that bill and to go through and because honestly, what we will be doing is then making recommendations to you and so you would see it in a new draft. And we're doing that because, honestly, just don't have time to go through in full committee fashion because I think you all recognize that we tend to talk a lot about, we can spend an hour on one piece of information and we're going to need to move faster than that. So you'll see a new draft of a bill. And then, as I said, Eric and Jubilee and I will meet, go over all of the feedback. I'm saying this out loud because I want you to know that it's not like we're not going to consider. And certainly, as you have read the feedback that has been coming in, in writing, if you have a question about a particular thing that we don't cover, I want you to certainly bring that up during our discussion. Or obviously, if you disagree with a recommendation that we'll make. So I just wanted you to know that. The bill is going to be a long bill. I'm just warning you. It's probably going to be, by the time it's done, upwards of 40 pages easily. So just be forewarned about that. Okay. All right. Anybody have any questions about what's on tap for this week? So six fifty seven, our homelessness bill and witnesses for pre K.

[Tim Lueders-Dumont (Executive Director, Department of State’s Attorneys and Sheriffs)]: Five eighty two today. Yes.

[Rep. Theresa Wood (Chair)]: And we have not only bills, but we'll have this amendment on the floor today. And I think that's it. You'll have a few minutes before we get to Florence, and Zon and I can touch base. Okay.