Vermont Legislature SmartTranscripts:

[Rep. Martin LaLonde (Chair)]: And welcome to the House Judiciary Committee this Thursday morning, January 15. And we're going to start with a drive by of a bill that is primarily in House Human Services, H5.5 addressing immunizations. And we're looking specifically at provisions related to immunity and gross negligence and those kind of things. And I'll just start with a I don't know if you have to have a thorough walk through just what you think is relevant to that question. Katie, thank you very much for being here. Yeah, you're welcome.

[Rep. Barbara Rachelson (Member)]: It's a frequent driver.

[Katie McBethough, Legislative Counsel]: Good morning. Katie McBethough, legislative council. I will pull up a draft here.

[Rep. Angela Arsenault (Member)]: Oops. I need sharing capability.

[Rep. Martin LaLonde (Chair)]: Yes. You're all

[Rep. Angela Arsenault (Member)]: set. Success. Here we go.

[Katie McBethough, Legislative Counsel]: So this is a bill that's in human services. I think it might be helpful to give you sort of a high level overview of what's going on, and then I can bring you to the section that I think this committee is most interested in. So this is a bill that gives the Commissioner of Health, the Vermont Commissioner of Health, the authority to make recommendations on the adult and child immunization schedule. Right now, a lot of our statutory language is tied to CDC recommendations. This instead would tie them to the recommendations of the commissioner. It provides some parameters that the commissioner would use to make those recommendations, including consulting with an advisory committee and looking at the recommendations of other professional organizations, including the CDC. This this bill looks quite long. This language as drafted is it's a sunset on 07/01/2031. So the bill is quite long because it puts back language in place that is currently in statute. So a lot of the language or the sections appear twice. Sort of the impacts of doing this is it allows the department to continue to order immunizations at the lowest cost, assuming that they're meeting the goals of the existing immunization program for the state. It provides continued insurance coverage for immunizations that have currently been covered as long as they're being recommended by the commissioner. And it also allows a pharmacist to administer an immunization that's under the commissioner's recommendation. So those are sort of the big things that this language does. Let me take you to the language that I think this committee is most interested in.

[Rep. Martin LaLonde (Chair)]: I don't know if folks saw the text from Nate that we're getting the latest draft that's being printed out right now, but we have it on the screen. So

[Katie McBethough, Legislative Counsel]: this is a draft that human services looked at yesterday. They've since made made additional changes and we'll be looking at a new draft. But this is sort of the most recent thinking. So it's this subsection C that they're thinking that you will have the most interest in. It says that a health care professional who prescribes, dispenses or administers immunization in accordance with the recommendations issued pursuant to subsection A, meaning the recommendations of the commissioner, shall be immune from civil and administrative liability for immunization caused adverse events unless the health care professional's actions regarding prescribing, dispensing or administering an immunization constituted gross negligence, recklessness or intentional misponduct. So this is language that when I was drafting this, I borrowed from opioid antagonist statute. We have similar language with regard

[Rep. Angela Arsenault (Member)]: to the administration of opioid antagonists.

[Katie McBethough, Legislative Counsel]: Is where that came from.

[Rep. Martin LaLonde (Chair)]: So the in accordance with the recommendations issued pursuant to subsection a, can we see what what subsection a looks like at this point? I wonder how much has changed since then.

[Katie McBethough, Legislative Counsel]: It's changed a bit. So this is subsection A that the commissioner shall periodically issue recommendations regarding which immunizations children and adults are recommended to receive, the age at which each immunization is recommended to be given, the number of immunization doses that are recommended to be administered, the recommended amount of time between doses of an immunization, and any other recommendations regarding immunizations necessary to promote the maintenance of public health and disease prevention in the state.

[Rep. Martin LaLonde (Chair)]: So if they follow those guidelines, those recommendations, then they are immune from liability unless it's gross negligence. Yes. But if they do something kind of outside of those recommendations, then that protection doesn't apply. And I'm not sure what that would be, but

[Katie McBethough, Legislative Counsel]: Correct. This is tied specifically to the recommendations that would be issued by the commissioner. So if they're if the commissioner recommends three doses of a particular immunization and a provider gives five doses of it, then going beyond what was recommended doesn't have these protections connected with that action.

[Rep. Martin LaLonde (Chair)]: But there may be something else that the doctor or nurse does that had nothing to do with recommendations that would be I can't think of they accidentally break the person's arm. I don't know those things. It's something that's extreme or not even extreme, but not related to the recommendations on how the doctor is dealing with a particular patient.

[Katie McBethough, Legislative Counsel]: This would be tied to an adverse type of reaction related to the administering of the immunization itself. So

[Rep. Martin LaLonde (Chair)]: how does this work in conjunction with the National Vaccine Injury Compensation Program?

[Katie McBethough, Legislative Counsel]: So my understanding is that right now that

[Rep. Martin LaLonde (Chair)]: If you could explain what that is as So

[Katie McBethough, Legislative Counsel]: that is a federal program based in federal law. Instead of going through a court law process, if a person has an adverse reaction to an immunization and they're seeking compensation, there's a process set up. It's still a legal process, and many people hire an attorney to help them through the process. But after filing various medical documents and a filing fee, there are attorneys who review the claim and decide if it will be compensated. My understanding is that right now, immunizations covered still reflect what had been recommended by CDC prior to the most recent changes. My understanding talking to the immunization expert at the health department yesterday was that that may be rolled back. So it would be limited to the immunizations that were just recently recommended. This language would provide protection to Vermont providers for the full complement of immunizations that are recommended by the commissioner of health in the state, even if those recommendations are broader than what is being recommended at the federal level?

[Rep. Martin LaLonde (Chair)]: So if somebody suffers an injury, though, from a vaccine immunization and it's not included in what the feds have, what can they do for getting compensation for that injury?

[Katie McBethough, Legislative Counsel]: Well, if it's no longer covered under the federal program, I imagine they could file a tort

[Rep. Barbara Rachelson (Member)]: suit. But

[Rep. Martin LaLonde (Chair)]: they and it would be a gross negligence standard that they would I'm I'm not sure.

[Rep. Barbara Rachelson (Member)]: Go ahead, Jennifer. So I just want to clarify. The pharmaceutical industry not industries are immune. Is that right? We cannot file a tort against?

[Katie McBethough, Legislative Counsel]: That is the federal legislation. And this process, the federal, DSIP was sort of created to allow for this process outside of tort law to happen. It's my understanding that in certain circumstances, depending on the outcome of that process, that there still are avenues to bring a tort claim. But the process is more limited. Right, so if

[Rep. Barbara Rachelson (Member)]: the pharmaceutical company can be found to be at fault, it may be that there could be some way to try to sue them. Otherwise, the tort claim that you were suggesting would be against the provider or against?

[Katie McBethough, Legislative Counsel]: Sorry, under the federal scenario or the state scenario?

[Rep. Barbara Rachelson (Member)]: State scenario. I'm wondering, for Martin's question, you said they might be able to file a tort suit, who would they file it against?

[Katie McBethough, Legislative Counsel]: There was, under this language, if it was believed by the injured party that a provider acted with gross negligence, recklessness or intentional misconduct, this language wouldn't prohibit any type of suit. They could go forward with that under this language.

[Rep. Barbara Rachelson (Member)]: And it would just be the provider, not like

[Katie McBethough, Legislative Counsel]: the This just covers the provider.

[Rep. Martin LaLonde (Chair)]: So if the National Vaccine Injury Compensation Program is rolled back to just the vaccines that are at the federal level, does that take away the immunity of the pharmaceutical companies for those that are no longer part of that?

[Katie McBethough, Legislative Counsel]: Yeah, I would assume so. So glad that the tort actions would be more

[Rep. Martin LaLonde (Chair)]: against the pharmaceutical companies covered in that.

[Katie McBethough, Legislative Counsel]: If and when that will happen, but it sounds like there is some belief that that could be an outcome of the recommendations being limited by the CDC during the past few weeks.

[Rep. Martin LaLonde (Chair)]: And to the extent that it is covered by that program, that preempts state law anyway. I mean, we wouldn't be able to go after those pharmaceuticals under state law because that federal law preempts. That's the way you get covered the injury. What we're trying to cover is the doctors, providers who are following the recommendations.

[Rep. Angela Arsenault (Member)]: Yes. The Vermont recommendations, yes.

[Rep. Martin LaLonde (Chair)]: Yeah, Ian, and then Angela.

[Rep. Ian Goodnow (Member)]: I think just one thing to note with this is that the on table, off table vaccine adverse reaction assessment that's done in the compensation program is very strict. Just because you have an adverse reaction or you have some sort of injury due to a vaccine that's on the table currently, if the reaction is not one of the ones that's labeled, identified, and it's not within the time frame that they identified, then you may not have coverage in the program anyways. So there are actually quite a few different potential ways where you might have a person who's not going to have an opportunity to access this program, even if they got a vaccine that is in the covered ones right now. Right. And again, that's the federal law.

[Rep. Martin LaLonde (Chair)]: Again, it exempts what we can do here.

[Rep. Angela Arsenault (Member)]: Yeah. Yeah. And my question is tripling down on this line of questioning because I want to make sure I'm very clear, I understand it correctly because I've gotten a couple of constituent emails and they are worried that we're providing immunity for industry. And I think they mean pharmaceutical industry. And I'm hearing you say that is not at all what we're doing. This is protection for Vermont health care professionals who are administering the immunization in accordance with the Department of Health, the Commissioner of Health's recommendations.

[Rep. Barbara Rachelson (Member)]: Thank

[Rep. Martin LaLonde (Chair)]: you. It doesn't provide immunity to industry. But federal law does submit.

[Rep. Angela Arsenault (Member)]: Yes. And that data preempts you from And I suppose one might argue that providers are part of the industry. But I'm hearing that the largest shield that exists is at the federal level. We don't affect that. We can't This language or Right. And this language still allows a path in cases of recklessness, gross negligence, true wrongdoing, but there's a chance for a patient to attempt to prove that wrongdoing. We're leaving that door open. Yes. Thank you.

[Rep. Barbara Rachelson (Member)]: Until this law is passed, if it is, if somebody in Vermont, child dies of the measles, because they could not get the vaccine, What can they Do you know if they can That's sort

[Katie McBethough, Legislative Counsel]: of outside the scope of this legislation. Yeah. Just wonder

[Rep. Barbara Rachelson (Member)]: because if time is of the I guess I'm trying to figure I mean, money is not going to bring back somebody who dies of the measles or whatever, but it seems like time is of the essence because we want to make sure people can get the vaccines that are scientifically

[Katie McBethough, Legislative Counsel]: I hear what you're saying. The conversation upstairs is reflecting that they have this taking effect on passage. And I think there's an interest in moving through the body quickly so the commissioner could pass recommendations.

[Rep. Martin LaLonde (Chair)]: Any other questions for Katie? Or did you have more, I assume, than

[Katie McBethough, Legislative Counsel]: I mean, you're welcome to look at the rest of the bill, but I think that's what you're most interested in.

[Rep. Martin LaLonde (Chair)]: This is just the part we're supposed to look at. Okay. We have all this for Katie. Okay. Can I have a word? Because

[Rep. Angela Arsenault (Member)]: I'm just not familiar with this area of law. Is there a Vermont specific adverse event reporting process?

[Katie McBethough, Legislative Counsel]: Not that I know of, but the health department is here, so they will tell me if I'm wrong.

[Rep. Angela Arsenault (Member)]: Think it's just the middle of the drills. Thank you. Okay. That will be the next one.

[Rep. Barbara Rachelson (Member)]: Yeah, thank you.

[Rep. Ian Goodnow (Member)]: Only one other question, just thinking about what we're actually asked to look at here. So the gross negligence standard versus a negligence standard

[Katie McBethough, Legislative Counsel]: Oh, I should have brought my chart. Let me pull up my chart while the other folks are presenting, I can get that for you. Great.

[Rep. Martin LaLonde (Chair)]: Great. Thank you, Katie. Yep. Alright. So we'll turn to Lauren LaLonde next, is, I believe Oh, here in person. I thought for some reason they were gonna be.

[Rep. Angela Arsenault (Member)]: What the wedding's gonna do.

[Rep. Martin LaLonde (Chair)]: Yeah. Was looking for you, Angela. Nice to have you in person. Thank you to be here.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: I'm Lauren LaLonde. I'm general counsel for the Department of Health. Sorry. And I'll probably just take a step back if that's okay to explain the ICP and the general immunization system at the federal level, because this system did evolve over the '80s, '90s, and became pretty comprehensive to insulate and provide access and protection. So you've got the FDA that reviews the vaccine and makes sure that it's safe. You've got the Advisory Committee immunization practices or ACIP and the CDC that provide guidance on use. Then you have state and the CDC provides communications and guidance and tools for providers to use, state and local health departments to use. And then they were finding that tort cases, which even one court case, adverse events are very, very rare, where ballparking, very rare, one in a million kind of thing. But they were fighting even that one court lawsuit is very lengthy, very costly. And it's deterring vaccine manufacturers from manufacturing vaccines and providers from taking that risk. So in the late eighties, they developed the vaccine injury compensation program, which right now under current state law or federal law, if there is any lawsuit, civil action over $1,000, it has to go to the ICP. It cannot go in state law, state courts or civil courts or federal courts, it has to. So right now manufacturers and providers are immune from liability over $1,000 for any vaccine injuries. And as Katie mentioned, there is a table of injuries, and I think you mentioned as well, that are known to be associated within certain timeframes with vaccines. And so if you come in, you petition for compensation and say, I have one of those injuries, you don't have to prove causation. So that's the excuse. They know that it's associated. You will most likely move faster through that compensation system. If you have a unique injury, then they will allow you to prove You still have an opportunity before judges and all the legal process to prove causation that this injury was caused by the vaccine. And so you're not shut off in compensation. So as was noted, those vaccines that are covered by the VICP have to be recommended, have to be There needs to be an excise tax associated with them from the Congress. And they need There's one other factor as well. But they It's not easy to add those vaccines. It is easy to remove them through regulation. There's concern at this point in time that this system that is very comprehensive, you've got the access, balance with the liability protection versus the recommendations is being slowly changed, creating a lot of confusion in the system. And what HY45 does is try to replicate what we can of that system on the state level. So allowing the dot, we have building our own ACIP, building our own access routes for the vaccines, building recommendations in the state. So we're trying to replicate that. We cannot replicate the entire BICP. But what this liability protection does is take a piece of that piece we can and maintain that liability protection for providers who are like we articulated earlier, acting consistent with the recommendations from this expert committee, from the commissioner. And so it is continuing that liability protection that's already in place, but on a narrower scale. So that's really what we're hoping to do. And what that does is provides comfort to providers, which allows us facilitates access, because really department's interest is that folks can still access to use vaccines and aren't deterred the providers aren't deterred from providing them because of the risk of one very lengthy tort suit.

[Rep. Martin LaLonde (Chair)]: Questions for Angie.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: Thank you. And is there anything, when a vaccine is recommended, or when a number of vaccines are recommended, in most cases, they are still just that, recommended. There's no mandate. Absolutely not. And so there's always the option for folks to just not get the vaccine, or whatever vaccines are recommended. Absolutely. Informed consent, working with your provider, all of those things are in place. There's no mandate here. This is a completely voluntary.

[Rep. Barbara Rachelson (Member)]: We

[Rep. Martin LaLonde (Chair)]: were talking about the manufacturers, and if their vaccine is taken out of the BCIC, is that what it's called, the BIC? I forgot to get my acronyms right.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: There's a lot of them here.

[Rep. Martin LaLonde (Chair)]: The federal program, if they're taken out of the federal program, our bill is not providing any immunization. Immunity, liability immunity. Yes. We're not providing an escape from liability in this bill for manufacture. They presumably are needing to deal with that themselves probably at a national level.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: Absolutely. Yeah.

[Rep. Martin LaLonde (Chair)]: Okay. All right. Somebody So who's injured can and if it's not under that federal program presumably they can actually bring it toward action against the manufacturer. They could also bring it toward action here if there's gross negligence. So we're not giving complete blanket immunity, which it sounds like the federal program does. I mean, if it's over a thousand dollars, it's got to go there period. Here actually there is an avenue of its gross negligence.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: Absolutely. And there's not at least in law a standard. So if somebody is grossly negligent and somebody brings a compensation claim, it is still considered by the VACP. Here it would not be. So there are a number of remedies and they can not only seek that, it is protecting physicians who are acting in accordance with the science that the state and expert committee have said, have reviewed and tested and they're acting in accordance with that, they should not be held liable if the product causes an injury.

[Rep. Barbara Rachelson (Member)]: So I got a chance to talk to Chair Wood, Break Report Committee, so I know that this bill doesn't attempt to touch, I think, the federal regulation about pharmacists. I don't know if it's federal or state regulation about pharmacists giving vaccines to children under the age of five. I've heard, and people I've heard from are so far not in Vermont, but I worry about that, just given our primary care issue, that it's sometimes very hard to get in to schedule an appointment, especially if somebody's working. The health department has felt that is not an issue we're of not in, or it's not in your wheelhouse to be able to do anything about that.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: Having both of those, think it's not really We want to encourage access in the safest and broadest way possible. And I think legislators decided a couple of years ago that this was the way to thread that needle. I think there's an interest in having children younger than five go see their PCP or the primary for reasons other than vaccines, which I think drove that decision. And so I don't think that the health department wanted to question that balance. I think with the recent changes that came out of CDC about breaking up how many vaccines you can get. It has created an issue because people are going in for their six month checkup, but they can't get all the vaccines at the six month checkup. And they have to figure out another appointment to get back in.

[Rep. Barbara Rachelson (Member)]: I totally appreciate that people should see their doctor. I'm just wondering if the health department is going to keep an eye out on if that ends up being a barrier for people and

[Lauren LaLonde, General Counsel, Vermont Department of Health]: anything that we could be doing to make that easier. I really think the recommendations from the commissioner could address that issue because again, those recommendations will include timing, will include dosage so that it might return. I can't speak on behalf of that expert committee, it might return to being able to get all your vaccines at one appointment. But certainly, will keep an eye on access issues. That's a huge public health concern. And if we're noticing a barrier, we will review that. Ian?

[Rep. Ian Goodnow (Member)]: Thank you very much for your testimony and for walking us through, especially the history of the Vaccine Competition Program. I'm going to try not to testify and just ask a question to you. It sounds like my understanding is this program is in flux on the federal level, that depending on where things land there, there could be gaps in how someone could seek compensation for an adverse reaction or something like that. It may not have to be a traditional tort claim. And that this bill has nothing to do with that. And that we are not impacting that program at all. And that even if this didn't exist, this bill did not exist, that flux and that question around protections for people is going to be happening no matter what.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: Yes. Yeah. And I want to be very clear that we're not even addressing adverse. Actually, generally, we're talking about injuries here that are associated with the vaccine, which are a nuance that I feel protective of as a public health nerd. I am-

[Rep. Martin LaLonde (Chair)]: I apologize for being wrong.

[Lauren LaLonde, General Counsel, Vermont Department of Health]: No, no, not at all. But yes, you're absolutely right. I think part of H545 is recognizing that there's confusion and a lot of change at the federal level, and it's impacting how people are able to access vaccines and what guidance is. So we're just trying to bring it down to a state level, make sure people have the information they need, it's consistent, it's clear, and it's scientifically sound and evidence based.

[Rep. Ian Goodnow (Member)]: Excellent. Thank you.

[Rep. Martin LaLonde (Chair)]: Not seeing any. We'll go to Stephanie Winters next. Thank you very much.

[Rep. Barbara Rachelson (Member)]: Good to be here.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: I have so many answers to a lot of your questions. And first, Stephanie Winters, I am the deputy director of the Vermont Medical Society, but I also serve as the executive director for the American Academy of Pediatrics Vermont Chapter and the Vermont Academy of Family Physicians, along with a slew of other organizations. But those are the main ones I'm here to talk to you today. First, I want to say, Representative Rachelson, a good way of making sure that we have access to primary care would be to support two bills in the legislature this year that would strengthen primary care, increase access, which is H680, which just dropped, or if the Senate takes it up first, S197. So those are two ways, instead of trying to find a different way to do it, let's fix our system first. So I'll get off my fully pulpit on that one. So I am here specifically to talk about H545, which is really important to our members and we strongly support. And I will just go through a few of the things high level of why we support this bill, and then talk about the immunity piece. So this bill aligns with national trusted organizations, such as the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, which is internal medicine, and the American College of Obstetricians and Gynecologists, also ACIP, so the Advisory Committee on Immunization Practices. So the commissioner takes all of those recommendations into account, follows up with our own Vermont Committee of Experts, which we have a lot of, and then makes a decision on what recommendations Vermont should follow. Doing this really provides clarity and consistency for our healthcare professionals and patients. There's so much confusion with all of the evolving measures, whether they follow science and evidence is questionable. And so how can we really shore up Vermont and the health of Vermonters? It strengthens the medical home and care coordination. So that's through standing orders, through our relationships with pharmacies and other licensed professionals to administer vaccines within their scope. And so it really provides central points for care coordination. It preserves the universal and no access to recommended immunizations, right now, the state covers all of that through health insurance, through state general funds, and that would not change. It would just change that they would follow our health commissioner. It supports a stable vaccine supply and reduces administrative burden. This committee may not have heard much about administrative burden, but I feel like if you ever go to your primary care, you know that there's a lot of red tape that you have to go through to provide healthcare in the state. And so being able to order vaccines through your health department, sort of have them show up at your door and be able to provide them at no cost is really important to provide that stable access. It ensures clinical expertise are central to immunization policies. So, the advisory council is named to have researchers, infectious disease, pediatricians, family physicians are obviously our health department, and so it has our Vermont expertise and then follows national guidance from organizations who have been doing this for decades. And then finally, the issue that your committee is looking at specifically protects healthcare professionals acting in good faith. So if they follow the commissioner's recommendations, they are protected. That's really important. When we saw some changes in vaccine guidance last fall, patients were coming to their practitioners and saying, I want this vaccine, and practitioners were like, we don't know what we're supposed to do. Are we at risk? Are we liable? Should we do this? What are the recommendations? And this really provides a stable ground in Vermont to be able to make evidence based decisions for your patients. And I would also say on the access piece about primary care, one, obviously supporting changes to support for primary care, but also, especially for children, I would say the access is a little different than in the adult world. And so being able to see your pediatrician, it's a little easier to get in than us adults, because family medicine and adult practitioners have a wider range and bigger breadth of responsibilities, but just for kids, it's a little bit different. So just in conclusion, we really support this bill. We hope that you will support the language around immunity, and we do need this now, so that is why it's based on passage. Thank you. Questions?

[Rep. Martin LaLonde (Chair)]: Angela?

[Rep. Angela Arsenault (Member)]: I'm curious if there have been are you aware of any reports of adverse events in Vermont and how they've been handled?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: I mean, I'm sure that there have been reports. Don't go on the vaccine. Anybody can go on to the registry and see reports and where they're from, so we could certainly get you information. There's always reports, and they range in complexity and severity. I think that there have been reports. I don't know how the VAERS program has handled them. And so I would just say, I don't know the answer to how they're handled. I think if you call your physician's office or your health professional's office with a concern, they talk you through that. They have shared decision making and they talk about what the adverse reactions are ways to help with that. But that is sort of a conversation between your healthcare practitioner and the patient. As far as the national VAERS, I think that's a whole process and how that's handled. Right, and is that something that

[Rep. Angela Arsenault (Member)]: the practitioner or the practitioner's office can help guide a patient through, if that's a route that they need to take for one.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Yeah, and the practitioners can report to that. If they feel it's a true relational cause, they report to bears. And so there is a role for the health professionals in Vermont to play.

[Rep. Martin LaLonde (Chair)]: Thank you. So just a couple other things. I think I'm going try to have a straw poll tomorrow on whether we're okay with this language probably tomorrow morning. The reason I'm going to put it off till tomorrow morning is there was somebody who asked to testify and just couldn't fit the person in, but it essentially gonna give the same testimony that she gave upstairs in the human services. So if people do wanna see that testimony, think it's somebody who may have sent an email to all of us, Allison Dispathy, I think is how you pronounce it. Her testimony was at 01:50 on Tuesday in Health Human Services. I'll give folks an opportunity if they do want to see that. She's a community member from Danville, Vermont. So also, I reached out to the medical malpractice lawyers community who would be the kind of entity that would want to bring these kind of cases. Essentially, they're not opposing this. Would say it's they're being neutral. They didn't feel a need to come in to testify because they're not gonna support or oppose. So I just wanted you folks to know that I reached out and I heard from three different attorneys in that community who essentially repeated what we've already heard that this is mostly done through this federal program which preempts state law. And they didn't have a problem with the rest of rest of what we're doing here. At least, they didn't wanna come in. They didn't feel a need to testify. So with that, we'll take a break unless there's other questions on on how we're proceeding. Kenneth? We're gonna hear from anybody that opposes us? I think that probably Alison is best pathy. The the testimony I mentioned is I believe she has a different perspective on on this. So I would suggest if you wanna see that, would suggest taking a look. Would be the same testimony here and we have other witnesses already lined up today and that's came in pretty late at the flesh. If you look at that and if you feel that we need to take more testimony, can talk about that tomorrow tomorrow and decide to do so. So, yeah, I'm happy to take more testimony if if if if we need to have more testimony. But from what I have heard, the testimony today, and you'll have an opportunity to watch what we heard today as well, Zach, and so will Tom and Alicia, so we can all be on the same page. And we can discuss it tomorrow. If we don't take the vote tomorrow and we want more testimony, that's what we'll do.

[Rep. Ian Goodnow (Member)]: You told Alison that you weren't interested in hearing from her?

[Rep. Martin LaLonde (Chair)]: I haven't gotten back to her yet. And I think essentially she said that she would be testifying the same that she already provided testimony. And I will email her as well.

[Rep. Barbara Rachelson (Member)]: Janet, can I just clarify? So planning to take Goslant up until tomorrow unless you hear that folks would like more testimony. If folks want what they should just let you know on what topic and who. Okay, great. Absolutely, absolutely.

[Rep. Martin LaLonde (Chair)]: All right, with that, we'll take a break until ten when we're gonna turn back to 05:41 of the