Vermont Legislature SmartTranscripts:

[Senator Ann Cummings (Chair)]: How did you pronounce? We are live. We are live. Is Senate Finance. We'll look back. And we have let me get back to the On the agenda two thirty seven, which is an accolade to prescribing by doctoral level psychologist, we walked through that bill last week with Katie. And going through it, I think we have it because it's setting up a new specialty, but I can't find any fee in it. It just believe recognizes that they might need a fee, and I'm assuming it might be the $100 that they just did with the optometrist. And there might be a fee well, that would be to the yeah. There might be a fee for the extra no. There would only be the registration fee, but they haven't set one yet. So we have it. We don't have a fee to approve. Senator Roth had asked for the why the limits were they couldn't prescribe to people who were pregnant, to children, and people 80, and here comes senator Brock. So I won't have to explain those concerns. This is $2.37, the the yeah. Prescribing by doctoral level psychologists. Mhmm. And since realizing that they will have to be working under a psychiatrist who is an MD and will thus have access to the medical records file, I'm feeling better. I was a no vote, but I was not clear on that fact in health and welfare. It's been a little less chaotic in here, So just try trying to get through all of them over the last week or so. And their subject matter tends to be more homogenous and things run together, lot of them they do in here. So I'm looking for are we ready to vote this out?

[Senator Randy Brock (Member)]: That we've deleted the over 80 piece?

[Senator Ann Cummings (Chair)]: We haven't. And we were told Mhmm. That it was a part of a compromise between the psychologist and the psychiatrist. I assume that geriatrics would get put in with pediatrics.

[Senator Randy Brock (Member)]: There is some reasonable cogent reason for doing it, I can understand it, but it is arbitrary, just as arbitrary as the same age restrictions are received in other professions such as the judiciary that we got put out.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Anyone on the sidelines like to answer that? Sure, I'd love to. Stephanie Winters, I'm the Deputy Director of the Vermont Medical Society. I'm also the Executive Director of the Vermont Psychiatric Association. I did send you all an email, I know you get a million of them, just outlining some of the key physiological changes and mechanisms as we age. I would say this is not anecdotal or arbitrary. These are based in science, so I can go through them specifically. I sent them last Thursday, Senator Cummings, around 09:57AM if you got them? No. Last Thursday. Last off. So And so far behind. I know. That's okay. As so as we age, there's reduced liver and kidney functions that process medication. There's increased body fat, decreased body water. So that increases the volume of distribution of drugs, like benzodiazepines. That's that's a mental health drug. It alters brain vulnerability, receptors sense sensitivity changes. A lot of medications can increase falls and fractures. There's some increased mortality risk as we age, drug to drug interactions. So there are certainly age related medication effects that aren't arbitrary, that are based in science, and the reason for the geriatrics is that a lot of my members actually think 80 is on the older side of what this cap should be. Geriatrics actually is defined at 65, and so having a rotation is still important because even if you keep the 80 cap, you would have fifteen years of potential patients, so you should be educated in geriatrics.

[Senator Randy Brock (Member)]: Well, seemed to me that based on that description, have some people who are 65 who should be excluded, you have some people probably who are 85 who should not.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Could have someone at 25 that should be

[Senator Ann Cummings (Chair)]: excluded, Precisely, it's so a a production, production, not

[Senator Randy Brock (Member)]: why do you select an arbitrary date that applies to some people that it shouldn't apply to?

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Just to be clear, we don't support this bill, so we did not pick this So

[Senator Ann Cummings (Chair)]: they would like it, I think, to exclude geriatrics. And where that starts, I don't know, 65? Is that 65?

[Senator Thomas Chittenden (Vice Chair)]: A little bit abruptly. Yeah.

[Senator Ann Cummings (Chair)]: Standard treatment.

[Senator Thomas Chittenden (Vice Chair)]: Clarify, this would prevent certain practitioners from prescribing it, but they would still be able to get these medications if they go to a primary care provider.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Primary care, psychiatry, yes. Okay.

[Senator Thomas Chittenden (Vice Chair)]: It's not stopping them from getting these drugs, it's just stopping this channel.

[Senator Randy Brock (Member)]: The only case has not been made, at least to my satisfaction, that that's a reasonable basis for making that determination. It seems to be arbitrary and somewhat capricious. There are some people who are, as you know, at 78, who aren't entirely, and you know who I'm, perhaps fall into a category of exclusion, and there's some people who are 82, 83, 85, who are not.

[Senator Ann Cummings (Chair)]: Okay. And

[Senator Randy Brock (Member)]: so I would not support a bill anymore then uses some other means of identification of a person to exclude them from something.

[Senator Ann Cummings (Chair)]: Well, we could make the medical society happy and go with excluding geriatrics along with pediatrics.

[Senator Randy Brock (Member)]: Pediatrics, that is a case of right basis based on age of juvenile where we do have things in law.

[Senator Ann Cummings (Chair)]: But I think geriatrics does too. Senator, do

[Senator Martine Larocque Gulick (Member)]: have I hear your point, Senator Brock, and I'm very sensitive to the fact that we have a provider shortage in the state, and

[Senator Ann Cummings (Chair)]: I think it behooves us to move this bill forward. At this point, if this is the only objection, I would welcome an amendment to strike, but that would probably get us into a committee of conference. And if we actually get an amendment, I would welcome a motion.

[Senator Randy Brock (Member)]: Well, I'd be happy to make an amendment. Again, I don't know whether the committee, whether anyone else on the committee besides me, wants to take the time to do that if you're not in favor of it, because the amendment would be passed.

[Senator Thomas Chittenden (Vice Chair)]: Could you clarify what the amendment you'd be more comfortable with, just striking

[Senator Scott Beck (Member)]: the 80, or are I you like the ivory

[Senator Randy Brock (Member)]: strike that term unless there's some medical reason for

[Senator Martine Larocque Gulick (Member)]: So you're saying

[Senator Randy Brock (Member)]: That it can be done in as arbitrary a fashion as that is done. If you say that a person should not, that the prescriber should not be able to prescribe certain things to individuals who exhibit these features, who have these physiological attributes, who have this type of blood problem as something that is specific to the individual that can be measured and tested. Yes, I'd say. On the other hand, I think picking A is just as arbitrary as picking race or gender or anything else.

[Senator Ann Cummings (Chair)]: So if we

[Senator Martine Larocque Gulick (Member)]: take geriatric out, that means

[Senator Ann Cummings (Chair)]: they want it says over 80 or 80 per block.

[Senator Scott Beck (Member)]: And just to know, could this work at 17 something, is that what age Oh, would that

[Senator Martine Larocque Gulick (Member)]: so you're, presenters, you're proposing that psychologists be able to

[Senator Ann Cummings (Chair)]: prescribe to any age.

[Senator Randy Brock (Member)]: Any age is appropriate unless there is some medical reason for not doing so.

[Senator Martine Larocque Gulick (Member)]: Okay, this just took out, mean, that's part of the

[Senator Randy Brock (Member)]: general Medical reason could be a blood condition, it could be a lung condition, it

[Senator Scott Beck (Member)]: could be all kinds of

[Senator Randy Brock (Member)]: things that physicians theoretically can measure that would make that person unsuitable for that kind of treatment.

[Senator Martine Larocque Gulick (Member)]: Yeah, that's the work of the doctors. Okay. The work they

[Senator Ann Cummings (Chair)]: would do.

[Senator Thomas Chittenden (Vice Chair)]: Senator Gulick's point, I'm just trying to frame this. Right now it says on page three, lines four and five, prescribed or discontinue prescription drugs for patients who are less than 18 years of age, over 80 years of age, or pregnancy. Would language that, and I'm going to look to Stephanie Winters to see if this is something that is at all defined elsewhere. Are you proposing, senator Brock, that instead of over 80 years of age, instead less than 18 years of age, geriatric? No?

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Or Stephanie Winters, deputy director of the Ra Medical Society, what I hear is that he doesn't want any CAP.

[Senator Randy Brock (Member)]: I don't want any CAP that is not measurable. Other words, that is not based on a factual determination, that's not based on an examination, but that is simply arbitrary and treating people at the age of 80 differently because there's some at the age of 80 who have a body of 65, there are others who are at the age of 80 who have a body of 95.

[Senator Ann Cummings (Chair)]: Okay. But it does do 18, which is also arbitrary. There are 16 year olds who

[Senator Randy Brock (Member)]: are juveniles and who can't drive, for example, at a That's right.

[Senator Thomas Chittenden (Vice Chair)]: Is geriatric measurable huge?

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Geriatrics is defined as 65 and above. Alright?

[Senator Ann Cummings (Chair)]: I think pediatrics is generally 18, but not adult. I'm going to say I think this is beyond the scope of this committee that has to us from health and welfare. I understand it's a negotiated agreement between the psychologist and the psychiatrist, And unless we get a voteable motion in about 30 I'll make a motion. Okay. To

[Senator Martine Larocque Gulick (Member)]: vote on and hopefully successfully pass out of committee draft number 2.1 of H237 from 02/11/2020. So,

[Senator Ann Cummings (Chair)]: Larocque Gulick has moved that the committee approve H two thirty seven draft number 2.1. Are there any Can I ask a question? Yeah. Is there any discussion? And then we'll go to any amendments. Okay. This came to

[Senator Martine Larocque Gulick (Member)]: your morning committee? Yes. And what

[Senator Ann Cummings (Chair)]: was your vote in the morning committees? Well, you were the only I was a no.

[Senator Martine Larocque Gulick (Member)]: You were a no?

[Senator Ann Cummings (Chair)]: And I'm I will vote yes here, and I'm dealing now that I've seen my concern was if you were just a graduate level psychologist, you didn't have access to the full medical, mostly prescription things, it's become clear to me in here that you actually have to be under a psychiatrist and will have access to that full medical record because the psychiatrist is positive. So you're feeling more comfortable? I'm feeling more comfortable. Okay. This issue did not come up in health and welfare per se.

[Senator Martine Larocque Gulick (Member)]: Okay. The chair doctor.

[Senator Thomas Chittenden (Vice Chair)]: I have a comment for the discussion. I'm going to vote to move this forward, but Senator Brock, very receptive to the point you're making. It does seem a little, I don't know, it preaches this strong word, but Aidan seems either arbitrary or otherwise, But I would encourage you if you go back to the Committee of Jurisdiction to Health and Welfare to propose alternative language, I would certainly welcome better language that you'd be more comfortable with than at the 80 degree, at the year threshold. But I'm fine with it from a finance perspective, I'm going vote yes.

[Senator Randy Brock (Member)]: Well, would say that obviously if there is a medical determination, the individual is too old or has a condition that would preclude that type of medication, I would understand it, But to simply pull a number out of the air is exactly the same thing that we've been fighting on when we talk about the judiciary. That saying a judge at the age of 70 is too old to be a judge.

[Senator Martine Larocque Gulick (Member)]: I did speak with the chair of health and welfare and she did say that she would support striking that age, if that's what we wanted to do.

[Senator Randy Brock (Member)]: Striking the age, I'm fine with the bill.

[Senator Ann Cummings (Chair)]: Could I get an amendment?

[Senator Randy Brock (Member)]: Sure, I would amend that, I would offer an amendment that the provision regarding the age of 80 be deleted.

[Senator Ann Cummings (Chair)]: Okay. So Senator Brock, I'm looking for page three into you.

[Senator Scott Beck (Member)]: So would it read prescribed or discontinued the prescription drugs for patients who are less than years of age or pregnant or pregnant. So we're striking the other thing. So we're

[Senator Ann Cummings (Chair)]: like Strike Mhmm. On line five, the over 80 years of age that we've been the or pregnant. Okay. That is the motion. Senator Brock has moved that on bill two thirty seven that on page three, line five, we leave in less than 18 years of age, strike out over 80 years of age. So it would be less than 18 years of age or pregnant. That is the motion. Okay. Can we get a card for the clerk?

[Senator Randy Brock (Member)]: Can sure Does

[Senator Ann Cummings (Chair)]: the clerk have a card? Is the clerk with us? I sure am. Okay.

[Senator Scott Beck (Member)]: Do we do do we need, like, a person that

[Senator Ann Cummings (Chair)]: actually doesn't draft? So we have a motion to amend?

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Got we got my We got Bernie.

[Senator Ann Cummings (Chair)]: Draft. Motion to amend.

[Senator Scott Beck (Member)]: Someone's gonna walk through that door in just a minute.

[Senator Ann Cummings (Chair)]: All those in favor, aye. Aye. All those opposed, nay. Nay. Nay. So I'm calling that at, what, 520 Thank you. For the amendment. Well, was a no.

[Senator Scott Beck (Member)]: It was a no.

[Senator Randy Brock (Member)]: Was a no.

[Senator Scott Beck (Member)]: Senator Hardy and Senator Cummings were not.

[Senator Ann Cummings (Chair)]: Oh, you were no on the amendment. Oh. Yeah. Okay. Now the motion is to approve two thirty seven as amended, and we will have to get read out here. No. Katie. To do a draft of this. But the motion is to approve h two thirty seven as amended. Is there further discussion?

[Senator Christopher Mattos (Clerk)]: I don't know if it was a draft number. It be

[Senator Ann Cummings (Chair)]: 2.1 as amended or 2.3.

[Senator Scott Beck (Member)]: Health did

[Senator Christopher Mattos (Clerk)]: draft 2.1.

[Senator Ann Cummings (Chair)]: So we're doing 2.2. So in terms of discussion, I'll just say,

[Senator Martine Larocque Gulick (Member)]: I think to Senator Brock's point, the medical determination is going to happen in the visit with the psychologist and with the collaboration between the psychiatrist and the primary care physician. I think that that is

[Senator Randy Brock (Member)]: It would be a medical determination based on the individual being examined.

[Senator Ann Cummings (Chair)]: Right. Okay. There's nothing to do Psychiatrist. The Psychiatrist. Alright. On this point, which I we will call 23.

[Senator Randy Brock (Member)]: 23 or 22?

[Senator Ann Cummings (Chair)]: 22 as amended or 2.3, I'm not sure what the drafter is going to call it. It is 2.1 as amended striking the phrase over 80 years of age, and Charlotte has blacked that out. We're get we're almost there we go. The commas will stay in or one of them will stay in.

[Senator Randy Brock (Member)]: Leave the space Alright. Leave one of the spaces there. Spaces in the comma.

[Senator Thomas Chittenden (Vice Chair)]: Is that an Oxford comma? And after age goes

[Senator Randy Brock (Member)]: there you go.

[Senator Ann Cummings (Chair)]: Stop with the Oxford. Alright. Is the further just the The

[Senator Randy Brock (Member)]: comma has to go out after age.

[Senator Thomas Chittenden (Vice Chair)]: Keeping

[Senator Ann Cummings (Chair)]: one comma in

[Senator Randy Brock (Member)]: No. Or not. No. Both comments go.

[Senator Ann Cummings (Chair)]: No. Okay.

[Senator Randy Brock (Member)]: And just No. No.

[Senator Scott Beck (Member)]: We're gonna

[Senator Ann Cummings (Chair)]: Prevent the comments. That's why we have editors.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Actually, guys, this is kind of Oh, come on, guys.

[Senator Ann Cummings (Chair)]: Is there further discussion?

[Senator Thomas Chittenden (Vice Chair)]: You struck that

[Senator Ann Cummings (Chair)]: in the words we're having now. Yes. We have moved we have struck that phrase over 80 years of age. Further amendment? If not, the clerk will call the roll.

[Senator Christopher Mattos (Clerk)]: Senator Chittenden? Yep. Senator Beck? Yes. Senator Hardy?

[Senator Ruth Hardy (Member)]: Yes. Senator Brock? Yes. Senator Gulick?

[Senator Martine Larocque Gulick (Member)]: Yes.

[Senator Christopher Mattos (Clerk)]: Senator Mattos? Yes. Senator Cummings? Yes. It's a strong seven zero zero.

[Senator Ann Cummings (Chair)]: Okay. What's that? For office reporting it.

[Senator Martine Larocque Gulick (Member)]: Well, you're reporting it for

[Senator Ann Cummings (Chair)]: It is committed. Yeah. Yeah. That's it. Okay. It's so striking. Got it. We found no fees in it. Alright. We now need to send a note.

[Senator Randy Brock (Member)]: Come to us in the first place. It's just a regular Okay.

[Senator Ann Cummings (Chair)]: That is what we have on

[Senator Randy Brock (Member)]: the agenda today. Why is it come to us in the first place? There's no fees.

[Senator Ann Cummings (Chair)]: Does her contemplate any future fees? It's, yeah. This is about the third one this year that the Secretary of the Senate has spent most because it implied that there might be fees in the future. We've gotten over three bills back. There was a milk. Why we got some of the bills regarding milk, I don't know. The other one, one Room 90, we went through last Friday. There's a lot of energy planning stuff in that. I've asked if that

[Senator Scott Beck (Member)]: House bill one ninety?

[Senator Ann Cummings (Chair)]: Yeah. It's one ninety? Nine forty. Nine forty. That's the right numbers. I've asked them if they'd like to take a look at it because we don't we haven't done energy planning. We have utilities. It's in our jurisdiction, but we really haven't found much in energy planning.

[Senator Randy Brock (Member)]: Those ten year telecommunications plan is an example, where we do our planning.

[Senator Ann Cummings (Chair)]: That's the utility. So I'm gonna have them look at it from the environmental perspective. I I will keep possession. I know that the chair of health and welfare would like to look at five eighty five. I'm not gonna give up possession of that either, but I would anticipate that Is that the

[Senator Martine Larocque Gulick (Member)]: one we went through through today?

[Senator Ann Cummings (Chair)]: Yeah. And there's implications in some of those things for the health transformation that we're going through. We seem to be on two tracks, probably because there's two committees of jurisdiction in the house. They have human services and healthcare. So, this came from healthcare. And what is the other one? I think that's it. The education committee is going to look at sections of the zeal bill. Apparently, there's things on special ed in there and one or two other things because I asked the secretary of the Senate why the tax bill go there. As soon as they finish, it will come to us. And Senator Bond Garth sent me a message saying they will work it out in due haste.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: They should not. I'm just looking at it right now. This is clearly a It's it's even the section that the secretary claims is the reason he sent it there is it's up to my hands.

[Senator Ann Cummings (Chair)]: It will come to us, but he the secretary said, we don't have to ask for it. It will automatically come to us.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: I will respect. I believe disagreement by the secretary on the phone. You too, but

[Senator Thomas Chittenden (Vice Chair)]: Yield Bill was an education. Oh,

[Senator Scott Beck (Member)]: Yield Bill had five sections. Sections, usually your Yield Bill is just one section. This one did a number of other things, including subject appropriations, section five, talks about special ed and grant amounts, and it seemed like if that was by itself, it might go to eds, so given that it goes by Rule 31 to here, it comes afterward to here and appropriations. The reason it probably did not go to ANOVA on the other side is it was committee bill that was introduced by ways and means rather than

[Senator Randy Brock (Member)]: a bill that went into play your beat up.

[Senator Scott Beck (Member)]: That's why. And not that it makes everybody happy, I'm sorry, but it just seems that there was that section, you guys will not miss your review and your rule allowed me to review everything in a bill under act 31. It's one of my favorite places. I never had the honor of serving in finance, but I think it's special in the rules when it comes here by rule 31. You can change anything in the bill.

[Stephanie Winters (Vermont Medical Society / Vermont Psychiatric Association)]: Including the age of somebody.

[Senator Thomas Chittenden (Vice Chair)]: But

[Senator Ann Cummings (Chair)]: speaking of that, I assume you're here looking for a bill. If we voted out two thirty seven

[Senator Scott Beck (Member)]: I just wanted to know senator Brock wanted me to upload her dinner while he waits for the event. Why did you not want it in a calendar to the model?

[Senator Ann Cummings (Chair)]: I don't if We can push it out a day. Yeah. If we can't get Katie, we'll just put it off a day.

[Senator Scott Beck (Member)]: It's fine. That's why I came down

[Senator Randy Brock (Member)]: to find out what your intent was.

[Senator Scott Beck (Member)]: I don't We will as you know, we'll wait.

[Senator Randy Brock (Member)]: You tell us to wait, but I have to wait till we

[Senator Ann Cummings (Chair)]: have This is not one of those. And if Katie's book is Katie's book, we can

[Senator Randy Brock (Member)]: irreparable harm, though, if we wait a day. Yeah. I don't wanna see

[Senator Ann Cummings (Chair)]: I think this may get us into a committee of conference, the medical society who's not happy that I left. Mhmm.

[Senator Randy Brock (Member)]: I'll have to go back and watch the tape.

[Senator Ann Cummings (Chair)]: But nobody's gonna be happy, I think, by the time we finish it. Mhmm. And, yeah, the yield build the yield has gone on miscellaneous tax before. Mean, it's like one sense, the yield is. But it also gets decorated or sometimes it's a decoration.

[Senator Scott Beck (Member)]: When you come over like this, you would have

[Senator Randy Brock (Member)]: Yeah.

[Senator Thomas Chittenden (Vice Chair)]: Bill owed. Right?

[Senator Ann Cummings (Chair)]: So we'll we'll get that, but we are gonna have enough. There is another tax bill headed our way.

[Senator Randy Brock (Member)]: I understand. It's it'll probably be referred tomorrow. It's a pretty intact. Mhmm. It's, 50 pages. Mhmm. So

[Senator Ann Cummings (Chair)]: between that and the two eighty $5.85, we are gonna have our hands full.

[Senator Randy Brock (Member)]: Anything else you need from me? Oops.

[Senator Scott Beck (Member)]: No. Perfect. Let me know. Thank you. Okay.

[Senator Ann Cummings (Chair)]: So we are done. We are off.