Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: You're live. All right, good morning. It's January 27. This is the Senate Health and Welfare Committee meeting, and we're hearing from two brand new witnesses from Department of Fish and Wildlife. So do you want to testify together or separately?

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: I'll probably join Jason. He'll be your primary speaker then.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright, perfect. Thank you for being here. And I don't know if you know everyone.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: I don't think I knew of them.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright, so we'll introduce ourselves. We'll start here.

[Sen. John Morley III (Member)]: John Morley, Orleans District. John Benson, Orange District.

[Sen. Virginia "Ginny" Lyons (Chair)]: Ginny Lyons, Chittenden Southeast. See you in appropriations of that?

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Yes.

[Sen. Virginia "Ginny" Lyons (Chair)]: In Cummings, Washington District. Behind you?

[Sen. Martine Larocque Gulick (Vice Chair)]: Good morning, Senator Martine Larocque Gulick, Chittenden Central.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Good morning.

[Sen. Virginia "Ginny" Lyons (Chair)]: Good, good morning. So why don't you take your name for the record and let us know why you're here?

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: I'm Charles Martin, the Deputy Secretary of

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: the Agency of Natural Resources. I'm Jason Batchelber. I'm the fish and wildlife commissioner with the agency. We're here for for an awareness discussion on on cost avoidance, food security, and and and health and welfare benefits that come from what I feel that the department offers as as sort of a an end goal of many as our as our biologists and our wardens and our technical staff march through their careers. Yeah. Charles Charles has been been kind enough to champion this effort for us and and get us in front of a few committees. I think a lot of folks tend to to forget about the the food security, mental health aspect, of fish and wildlife in in 2026. I'll just give you a a quick background. I'm I grew up in Derby, twenty year game warden, and retired as as chief warden in 2022. Became a full time dad and and a food provider or attempted food provider. And rel relevant to the discussion today. And I came back as DEC commissioner in 2023 to work for Julie Morgan, and this job came over last year in July, I stepped into that. So that's that's my background. But I've got Abigail the screen helping us through the slides. I don't know if you'd like me to put those up or not.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. So does she have permission, Melissa? Ahead?

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: So I was just she wanna there we go. Terrific. So that's my first slide. So hunting, fishing, and food, and the nutritious nutritional significance of wildlife conservation in Vermont. I think my first slide and your first slide are different, but, Abigail, you can jump to this to the next slide. So hunting and fishing in Vermont, we understand that that folks perceive us in a in a bit of a decline in in interest and participation, which is which is mostly untrue. Numbers wise, yes, we have we have less folks buying licenses, but we have very strong participation across across our demographic here in Vermont. And if you look at those numbers, they're they're they're very, very strong. They're very real. Our our participation rates are are pretty extraordinary. We do see declines where we have demographic declines. It'll be very young kids. We don't we can't sell licenses to kids we don't have, but we we certainly the folks that that are in the game are participating at a at a very high level. And 109,000 residents hunters and and anglers, which the one in one in six folks, I think we all participate or or know someone very close to us who is a hunter, angler, trapper. And there are some towns there that correspond with those numbers just for your interest. Next slide, Lee, Doug. When we go to work every day, we feel protecting Vermont's fish, wildlife, and plants obviously is our is our charge. For me, especially, the jobs that I've had, DEC here as as a warden, for me, providing these sustainable hunting and fishing opportunities affordable and offering ability for folks in Vermont to gather a meaningful amount of food from the land was always my goal. I was always raised to what I chased, what I caught, what I killed. And I think the folks that are coming at this in in 2026 or or living it in 2026 are almost exclusively doing it for those reasons, lifestyle, food, and and for your purposes here, a strong mental health component. Speaking for myself, my wife knows that I'm a kinder, friendlier person to be around. I've never been on the woods for a good long time.

[Sen. Virginia "Ginny" Lyons (Chair)]: Actually, there's a lot of literature that supports that.

[Sen. John Morley III (Member)]: 100%.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. 100%.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Yeah. Yeah. Abigail, next slide, please. I think this gets into it. I guess it's a subsequent slide, but just some some cost and affordability that go along with that messaging. My license costs quite a bit more because I have every every tag that's offered by the department. But if if you're looking at fishing license or a hunting license or or something similar, you're talking about pennies a day if you're buying in January. Add ons cost a little bit more, but as as slides go on, we'll we'll show you what what those are actually gonna bear out for folks. If I I like to add it. If you if you wanted to take these these pennies and translate them into into opportunities for yourself, if you really had the time, which is a is a factor, this could translate into into serious economic gain for you, probably not a a good choice of food game for you if if you so chose at a at a very low rate. Next slide, Abigail. This is the one I was looking for. So the the motivation to hunt nationwide is is driven by by the desire to have meat in the freezer or on the table, And and fresh fish is a top five motivator. People tend to get into the fishing aspect for social reasons as well and and others. But hunting, I I think we're still close enough to our ancestors that folks wanna provide to me when they go hunting. It is a lifestyle for a lot of people, but at certain times of the year, folks shift toward wanting to put protein in the freezer, and Vermont certainly offers that. So it's the the most important reason that people bear hunt in Vermont. It's the most important reason people hunt for small game in Vermont, and the third most important reason for waterfowl hunting. We don't have any recent research on deer hunters and anglers, but if if you all know them and and grew up around them, I'm here as as one telling you that's why I do it. I have Okay. Three deer in the freezer, and I'm already worried about running out. Probably shouldn't be. Sir. Well

[Sen. John Morley III (Member)]: On that mind, what I had for

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Christmas dinner at my sons with their medicine, fresh fish, and vegetables out of their garden. You go. There you go. I I get to be more selfish at home. My wife doesn't eat meat. My kids all devour it, but I I I get the four of us get it. My wife doesn't doesn't partake in it, but I I'm with you. It's a it's a big driver, and I think if you asked a line of hundreds in November why they were going out, that'd be the the main reason for the the the heritage, which leads to the food security, and and the meat aspect is is by and large front center people's minds. Next slide, please.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Focusing a little bit on pandemic surges and times of of of uncertainty for folks, There was a study done by UVM and and UMaine that showed that that the food security angle was hugely present in people's minds when they when they were experiencing times of uncertainty. COVID, I think everyone knew we were in a in a in a huge bubble of license sales, huge participation, during that time, and food insecure households were much more likely to partake in those activities. Interest and participation in hunting and fishing as a food source increased wildly. And we had a little bit of a hangover from that, and now we're back to our our pre pandemic license sale data. And and and a a quick note at the bottom there, in 2021, it showed that that hunters and anglers by ZIP code were slightly less by immediate income than than the rest of Iran. And that some of that is nuanced through through geographic needs based, but I but it it it does show that that folks that, probably live more rurally on the landscape think about this as a more acutely than others, but more to show that at times of crisis, folks turn to the woods, and I think that's a long term study in progress as we sit here today. Next slide, please, Danielle. Showing some of the rewards for the for the effort. Some of these are some of these are pretty stark, but I think some of them are fairly obvious too. Looking at the pounds of harvest and and the offer that that comes from from hunting your own meat, these are averages from an animal. Some of obviously, some some moose are much bigger and some deer are smaller. These are averages. And that number at the bottom, we're we're trying to be on the on the the three times conservative side. So likely, this is probably triple in in value what you're looking at today, but using ground beef as an example. We all know it's expensive. But lately, these these these numbers are are higher than you see. But and and try not trying to to to add a dollar value to someone's experience or someone's mental health or or to someone's protein in their freezer, but as a cost avoidance measure, these are these are real numbers, and this is this is real poundage that folks experience. I want you to strap like that a little Yeah, please.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. That doesn't end up in my freezer. That's the problem. We've had a really long time where we haven't done. I think we have some more muffins. So

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: Jason talked about it earlier, but when when we came up with this number, again, being extremely conservative using inorganic ground beef as a poundage

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: Oh, wow.

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: To come up with a six point 6 plus million dollar value, it's We didn't want to monetize it and oversimplify the species to that level, but we did want to say and point out that's a cost avoidance for Vermonters. I certainly grew up in a community in Prince, Vermont where this wasn't a good to have thing. It was must have thing for a lot of families and a lot of my friends' families. And if you think about 50 pounds of venison, if I invite people, some of these websites are not reputable and it's legally fabulous, so please don't make a transaction. But if you look at the internet value of Benson, for the fact that one whitetail is about 50 pounds of meat, we're looking at an average of $20 a pound times 50 for just one deer, and are predominantly skewing lower half of income hunters and anglers have this opportunity to put that food in her freezer and not have to go stress the way in the grocery stores. Think that's just a

[Sen. John Morley III (Member)]: huge No.

[Sen. Virginia "Ginny" Lyons (Chair)]: Does. It obviously is gonna save people on the grocery bill.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Absolutely. Anti healthy, envy, social, and Yeah. All of the other Yeah. All the wonderful things. Yeah. Trying to put it into a package in my head is hard. But I certainly don't know what I would do without that opportunity. Next slide, please, out again. There's some numbers here with regards to pounds of big gain through regulated hunting over the years, showing fairly steady. '22, there was a blip that was part of our our COVID hangover. When when you don't see the numbers decline, I I wanted to point out we took this slide to point out that we are offering more opportunity every year for hunters, and anglers. We we're upwards of of forty five more days of of archery hunting than we were just a few years ago. This year will be the first year of the expanded archery season where you'll be able to hunt early. And and, for example, Downtown Montpelier with archery equipment for analyst here for sixteen additional days, you have access to folks who wanna relieve themselves of some of their hosta eating here. That'll be opportunity for you. But just just a fun slide there to show you year over year what we're looking at and how people spend their time and how they come across those numbers. Next slide, please,

[Sen. John Morley III (Member)]: A

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: quick snapshot on on small game and waterfowl. We have we have long and liberal seasons, and and while it it may not seem a a meaningful way to to acquire a lot of a lot of protein. These are are are ways that folks get into the sport, very social and and very educational ways for folks to start out in into their into their hunting careers. In Vermont, ruffed grouse is the most popular when you ask, but gray squirrel is is increasing over time, mostly among young hunters in the Champlain Valley and and New Americans. So a lot of the studies that we've seen in New Americans in Vermont are coming from places where slow is very popular, and we certainly do have the the ability to sustain an increased harvest. Ducks and geese, we we are we are fortunate to be surrounded on on couple sides by a lot of water. So we do have a lot of lot of ducks in Desaw, but we have liberal seasons. Ducking and goose and and other waterfowl hunting can be intimidating to some folks, but we do harvest quite a few here in Vermont, worth pointing out. Next slide, Algo. Fishing is is tougher to equate because we we tend we we don't have to report, and so we don't exactly know how many fish people are bringing home. But looking at it as an opportunity, our our fish culture, our hatcheries provide the opportunity for folks to bear out these numbers every year. We do do stream side and creel harvest surveys, and folks are catching and folks are eating these fish. I'm I'm one of those. But we we spend a lot of time ensuring that there are sustainable populations of fish on the landscape that that do translate into great opportunities for folks to catch and and bring home food for the table, and and we do see a lot of folks doing it. And looking at the the aspect from a from a holistic approach, our our access areas where we put these fisher eggs are accessible to many, many, many folks within a short drive. Next slide, Abhil. So some more one off opportunities that the Department of of of Fish and Wildlife provides for folks. So we maybe maybe seven, eight years ago, we started a program called Penicillin for Vermonters where we take roadkill that folks don't scoop up on their own and and process it in house. So senior warden Abigail Sarah from originally from Newberry. She's down in West Rutland now. And and Jeff Lippl, who's the sergeant down that way, have a processing station at one of their houses where they accept donations for packaging, and and they process hundreds of pounds of meat. Every so often, they they amass it, and they have a cutting day, and then they provide it to food shelves, and it's and it's very, very popular. It's very, very desirable. It's very healthy. That's something that that the department offers. We do Let's Go Fishing clinics to get people into these activities. We have a fishing festival coming up on Saturday in my hometown of Elmore. It's gonna be chilly, but bring your friends. Be a lot of lot of hot tacos and a lot of lot of fried, hot fish to eat if you want. It'll be a great day. And then we partner with Vermont Wild Kitchen, rural Vermont, and seminars, farmers markets, and and classes at UVM would We've done events here at the State House too that some of you may have heard partaken in, which is a lot of fun. Next slide, please. And this is just to point out that round up the conversation that I I started in the beginning. So when we look at our our charge as a as a department, we we truly go to work every day to to manage our species in a way that all Vermonters can enjoy them. But looking at at deer, bear, moose, turkey, fish, as a as a a food source is is a responsible endgame for those efforts in my opinion. And and something that not all Vermonters enjoy, but I think all Vermonters feel is part of the grit and the fabric that that makes Vermont very special. And and I think every technician, every biologist, every warden, every every manager in the department goes to work every day to ensure that. Anyway, that's enough on that, but I I I know you you likely likely feel it in a way that I can't articulate, but thank you. And then last slide, So, again, our our mission is the conservation of fish, wildlife, and plants for in their habitats for the people of Vermont. Our landscape is a is a significant source of wild food. It's open to everyone, and it's sustainable thanks to habitat conservation and regulated hunting fishing, something that that I think is a is an example nationwide and and people. But I'd love to take some questions and and lean into any of these slides if you'd like. I know you're short on time.

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: I'd also like to just make it clear, we don't have any ask today, so the takeaway for the committee is just simply that when you invest in the department and state lands, it's not just the stewardship investment in those lands. It's investment between security for Vermonters, particularly when these opportunities are in rural areas and there's a lot of

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: hunters and fishermen. Thank

[Sen. Virginia "Ginny" Lyons (Chair)]: you. This has been terrific. And here, it's not just the benefit of being out walking in the woods, it's also the nutritious food that you get when you're out there. You don't do the foraging. You do protect plants. But what about my family that got filled with foragers?

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: So I've been thinking about the foraging because I'm a forager myself.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, good.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: And and fungus have made it into our state wildlife action plan, the twenty twenty five rendition this this year, which we're taking public comment on. So we're we're certainly, as a department, responsible for those species. I I I would have to get an education before I I

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, so now thinking about your relationship with Forest Parks and Recreation and when a tree falls down, maybe it's a beech tree and then we could get some lion's mane. And also those kind of things, those connections that you make between your two Oh, for sure. Apartments. Right? And then the beer, the the deer, love, some of that stuff too. So that's to be a competition. Or he gets it first. Thank you for that. This is terrific and it does open up a little bit our thinking about your role, know, as you can see bills coming through and the importance of sustaining fish and wildlife in the state. I

[Sen. John Morley III (Member)]: think from my perspective, anyway, sea noise. How is the licensing funds doing in terms of support of the agency?

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Year year to year right now, it it's it's a it's a steady decline, if you look at it from, from a historical perspective. We're we're losing our, our our youngest of the young recruitment. However, on on the flip side of that, and and that's for for the for the purchasing power of your year licensing. So if you're looking at the flip side of it, we have a a statistic that in in in recent years, so up up to this date, upwards of 20%, it's around 19 and change of newborns in Vermont get a permanent, lifetime license. So we we get that money and we we invest it, but it's not it's not, it's not money that we can count on as part part of our annual license sales. So there's a there's a nuance to to every number that we look at. We're we're roughly a third funded by license sales, year over year license sales right now of our 33,000,000. We get about around 10,000,000, a little bit little bit more of of of license over here. And those are the lifestyle folks who pay routinely into the system. We do have the the permanent license sales also for folks 66 who pay the one time. Yeah. My dad my dad. My my mom, I think, has the fishermen. But, yeah, and that that that's invested as well. Those are participants. They are not they are not counted toward our license sales. So when looking at license sales as a as a a snapshot, it's really challenging because of those numbers. And that's why we lean in on the participation side, the 109,000 people who are participating. They're not all licensed they're not all, like, licensed sales. Right? They're they're they're folks who haven't purchased or or have been been through through someone else's good grace given a license at very young age, or they don't need one until they're 15 or honeymaid wood. But, yeah, we we tend not to be able to to capture those year over year because they're not they're not buying. I think admittedly overall, because of our demographic shift, we're certainly lower than we were in the eighties.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Those have been terrific, Honestly, I have a lifetime license.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: And I don't use it all the time. So, you know, it's I use it all the time. Yeah. My husband's too.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Sure.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's good. So thanks for being here.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Thank you for having us, missus Lewis.

[Sen. John Morley III (Member)]: It'd be

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: marvelous and happy to come back anytime.

[Sen. John Morley III (Member)]: I'm sure we'll see you all.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, we might think about that. As long as you know, maybe a little another taste test.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: I I have to check on that. I almost said we have something scheduled, but I wanted to make sure.

[Sen. Virginia "Ginny" Lyons (Chair)]: I don't know. I know ag sometimes brings in all of the sort of cottage industry and others, so it'd be interesting.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Yeah. I think we do have something scheduled. We even have a vegan option, which will be foraged, I think. Yeah. We'll stay tuned. But thank you all so much.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you.

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: Thank you.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Alright. Have a great day. Good.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's so kind of news.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Thank you, Abigail.

[Sen. Virginia "Ginny" Lyons (Chair)]: They did bring in taste for us today. Oops.

[Sen. John Morley III (Member)]: Never impressed with my son.

[Sen. Virginia "Ginny" Lyons (Chair)]: So, consequences of getting the wrong one are too severe. Yeah. We're gonna move on to S163 and this is the Do you mind closing the door if you come in? That's great. We've been through a walk through on this briefly. Got it a couple of times. Do want me to

[Jennifer Carbee (Office of Legislative Counsel)]: remind you what it is? That would be helpful.

[Sen. Virginia "Ginny" Lyons (Chair)]: And and then we'll Okay. And I don't think that I don't think that in green will be testifying this morning. She's here.

[Devon Green (Vermont Association of Hospitals and Health Systems)]: Right here. I'm here, but I'm here to listen.

[Sen. Virginia "Ginny" Lyons (Chair)]: You're here to listen. That's what you had contacted me and that's fine. And we'll get you back in ASAP. Great.

[Jennifer Carbee (Office of Legislative Counsel)]: Good morning, Jen from the Office of Legislative Counsel. Just to remind you briefly, S163 is an act relating to the role of advanced practice registered nurses in hospital care, and this adds a specific reference to Advanced Practice Registered Nurses, or APRNs, in a couple of different places in the statutes. One is in the Patient's Bill of Rights for Hospital Patients, specifying that it may be the APRN who is the attending provider responsible for the patient's care, and adding that reference in or out that it may be the physician, but it may be a physician or an APRN, and as a result, complaints be directed either to the Board of Medical Practice or the Office of Professional Regulation, and adding in some references to osteopathic physician license chapter in addition to system references to the MD or medical practice based physician chapter. And then chapter on hospital licensure requirements, adding in that patient's admitted to the hospital would be under the care of a state licensed physician or advanced practice registered nurse. Adding advanced practice registered nurses in two places where they are not currently mentioned in statute and where in fact specifically says physician, but I believe you've heard from OPR that this is within the scope of practice of APRNs, and they suggested taking out some additional language that is in the bill as introduced, requiring physician consultation and support to be available, and they said that's not required, existing scope of practices would actually be a narrowing of the authority and so recommending that that language be struck.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So the other addition is OPR because it is an APRN. Right, and also adding in

[Jennifer Carbee (Office of Legislative Counsel)]: some specific references to osteopathic physicians who may be the physician and they are regulated at OPR, not work medical.

[Sen. Virginia "Ginny" Lyons (Chair)]: Questions for Jen? All right, good, thank you. Okay.

[Jennifer Carbee (Office of Legislative Counsel)]: Always good to have her in

[Sen. Virginia "Ginny" Lyons (Chair)]: my hair, especially after a snowstorm. Alright, so we have Michelle Wade, nurse practitioner from the Nurse Practitioners Association.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: I think we're gonna co testify with you. That would be great.

[Sen. Virginia "Ginny" Lyons (Chair)]: We'll go into Michelle and Jane together. Yep. That would be fantastic. And then she

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: Pop right up there, Jane.

[Sen. Virginia "Ginny" Lyons (Chair)]: Can I ask the other two folks who I I know who Devin Green is? I don't know you, but do you mind just Oh, we're just interns. Just taking notes. Interns for? For Gail and Zach. Or Gail Zaps.

[Jennifer Carbee (Office of Legislative Counsel)]: Oh, those should be interns.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Thank you. Thanks for being I thought you might be a parent. Just check.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: I think I had a number watching online this morning.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, there are everybody's online. Sitting Senator Gulick, who is here with you, and I think what we'll do is we'll introduce ourselves because you don't know us. I mean, I'm gonna introduce you you. John Morley from Orleans.

[Sen. John Morley III (Member)]: John Benson, Orange District.

[Sen. Virginia "Ginny" Lyons (Chair)]: Ginny Lyons, Chittenden Southeast. Ann Cummings, Washington District. Behind you is Senator Gulick.

[Sen. Martine Larocque Gulick (Vice Chair)]: Hi, I'm Martine Larocque Gulick, Chittenden Central. Nice to see

[Sen. Virginia "Ginny" Lyons (Chair)]: you. Thanks.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: And for the record, I'm Michelle Wade. I'm the President of the Vermont Nurse Practitioners Association. I'm Jade Kaplan, I'm

[Jennifer Carbee (Office of Legislative Counsel)]: a member of the Vermont Affiliates of the American College

[Sen. Virginia "Ginny" Lyons (Chair)]: of Nurse Midwives. So we came

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: in today to speak with you folks about S163. First, thank you Madam Chair, members of the committee, the opportunity to testify. I did submit written testimony, and I'm one of these people that doesn't like to read what I already submitted, so I'm just gonna do some bullet pointing. I just wanna emphasize first for everybody though that advanced practice registered nurses already have, as OPR stated, the education, training, and legal authority within our scope of practice to admit and attend to patients. So this is not a change in scope of practice. This is not an expansion of anything. This is really just some language cleanup that has been in statute that needs to match what our scope of practice is. And that was the whole intent of us submitting S163. These responsibilities that we do on a daily basis naturally include admitting and attending to our patients, and we're already doing it on a daily basis. As a matter of fact, when I leave here today, I'm going back to my hospital and take care of my patients that are on service right now. What is your hospital? I currently work at Gifford in Randolph, so.

[Sen. John Morley III (Member)]: All right, that's

[Sen. Virginia "Ginny" Lyons (Chair)]: your fault. So

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: these functions really ensure continuity and accountability as well, because it means that you're having the same provider during your entire hospitalization to take care of you, and it's not flip flopping between either someone who's out in the community trying to take care of you while we work as hospitalists, or a physician today, an APRN tomorrow, a PA the next day, we're allowing continuity of care, which is very important when you're trying to move people through our hospital system in a timely manner. Also, I want to talk about the rural nature of Vermont. We have multiple rural community hospitals and critical access hospitals in our state, and we already serve in these rules in these states. Clear statutory language reduces confusion, and it promotes consistency across our entire health system. Data integrity is also very important and lost because of this. A key secondary benefit to this change will be accurate data collection. If a patient's admitted in my name, taken care of by me, and discharged by me as the advanced practice nurse, all of the data relevant to that patient will be data mineable under my name. Right now, that's not necessarily the There's physician names on the records, and it's unclear where that data goes. Jade is gonna speak in just a minute a lot more about data. When APRs are not listed, our work also becomes invisible. All providers, physicians, nurses, PAs have an NPI number, and that's where much data is mined from. And if that NPI number is not the number of record, then data mining is again interrupted. And clarifying this will help accurately capture the full contribution of ABRX. Jada's gonna speak about data for just a minute.

[Jennifer Carbee (Office of Legislative Counsel)]: Okay. So I am a resident of Charlotte. However, I work in NVRH at St. Johnsbury. So I'm particularly in love with the Northeast Kingdom.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: I just haven't been able to get my family to move there with me. So I've

[Sen. Virginia "Ginny" Lyons (Chair)]: been working We got

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: a queue in Charlotte.

[Sen. Virginia "Ginny" Lyons (Chair)]: I love Charlotte. Absolutely.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: My tenure at NBRH has been nine years full time now, and I've been a nurse midwife, APRN, for over thirty five years. So I've been doing this a while. When I admit a patient in labor, or for any other reason, a maternity care patient, to the hospital, I'm lucky enough to be working at a critical access hospital that does recognize full practice authority from its APRNs, and so my patient has my name on their bracelet. They know who admitted them, who's taking care of them. I am the admitting provider, I am the attending provider, and unless we switch shifts and I have to go home and somebody else needs to take care of her, the midwives are going to be the discharging provider. It's very clear for patients when they can see the person that's caring for them and know that person and knew them before they were admitted with midwives who have continuity of care, prenatal care, so they're getting care from the same people that are delivering them. And they don't have to have a physician's name on the bracelet that they've never met that they're not going to be getting care from unless they risk out of the care of an APRN. So I just wanna point out that from the patient's perspective, this is a very valuable thing to have, but not all hospitals in the state have this, And the bylaws of the hospital control that. So even if we get the things that we're looking for from S163 passed, it doesn't require hospitals to do it. They will still have individual control of how they want to do their bylaws. But it does allow hospitals to clearly make the change, have APRNs, have admitting on record if they so choose. So, I'll speak to that. And then the data, which for me, I access through the birth certificate data. Anybody can, it's online, it's free, it's a little bit behind in terms of years. Basically, thirty to thirty three percent of Vermont babies are being delivered into the hands of certified nurse midwives currently. What we don't have any data on is how many more women are getting prenatal care and other types of GYN and family practice care, not family practice, family planning care from nurse midwives because that data is not captured in any way. So if you extrapolate, say, another twenty percent of women are getting care from nurse midwives that end up being delivered by physicians because they've now risked out of the care of the nurse midwife. The midwife has collaborated, consulted, or referred appropriately according to her scope of practice to the OBGYN, and then the lady ends up being delivered by the physician. That woman is counted toward physician deliveries in the birth certificate data, and all that care that the midwife provided prenatally and will probably continue to provide postpartally is lost to the data. So if you extrapolate, except a fifteen to twenty percent transfer rate, it actually could be, theoretically now, because I don't have this data, it is invisible. Over fifty percent of the women in Vermont are touched in some way during their pregnancy by nurse midwives. But again, we don't have the data. If we don't have the data, it's very difficult to design rural transformation without accurate data. We can't create funding priorities and we can't create food policy because we don't know what's going on in the state with regard to women and their care providers. So that's my data piece. I also want to point out one more thing, that at NVRH, the last time I checked, 60% of the providers that are on medical staff are non physician providers. So all of those APRNs and PAs require the collegial presence of physicians in order to remain within their scope of practice and collaborate, consult and refer appropriately. So, this is not in any way a change in practice. It should not be any kind of threat to physician presence because we need them.

[Sen. Virginia "Ginny" Lyons (Chair)]: I just want to point that out. Understood. Thank you. Thank you.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: I want to bring it back to workforce for just a minute too. When we talk about workforce, this actually will support recruitment and retention because our colleagues in New Hampshire already practice this way, and their facilities already do not have this restrictive language in their statute. Most of their facilities are governed by full practice authority, which is what the state rules state. Don't have this extra statute. I believe you have submitted testimony, or received testimony from Maureen Boardman, who practices at a bordering hospital, but is a Vermont resident and practices at Little Rivers as well, and she speaks to that in her testimony. Additionally, we've already talked about aligning, I won't go back there again, but there's unnecessary administrative steps currently. This would allow the hospital and the physicians to streamline those. We absolutely need our physician colleagues. We are not asking for that to go away. But, there are times when our physician colleagues aren't needed because the care we're providing is wholly within our scope of practice. It is very straightforward, perhaps heart failure patient who just needs to come into the hospital, get some extra IV diuresis, get their breathing control again, and can be discharged back to the community with a changed plan of care. We may not need a physician colleague to help us with that plan of care, but currently, they're being required to sign off on paperwork and follow along with those patients. So this is about streamlining and having them available for when we need them for those ICU level care patients or those complex patients where it's outside our normal scope of practice. Clearly, I won't say though APR is practiced in ICDs, but we practice much more collaborative cause it's a higher level of care. Lastly, or second to lastly, sorry, this reduces handoffs. Reduced handoffs is a safety point. There's all kinds of data out there that every handoff creates an opportunity for error. I witnessed that this morning at my hospital, when I received handoff back on a patient, and I said, What about XYZ? And they said, Oh, so and so didn't tell me that, because I had had this patient several days before. So handoffs are not a great thing, and this will reduce handoffs. It will make care more efficient, and will improve patient experience. I'm not gonna speak any further to date. Think Jay did a really good job with that. What I would say is we do concur with OPR's request to strike the proposed language on page two, lines 13 through 15. I won't quote it, you know what it is, you can see it. But it restricts our existing scope of practice. I'm happy to quote it if you'd like me to, Chair. Sure. Quote, Physician consultation and support shall be available to an attending APRN at all times in accordance with applicable standards of practice and regulatory requirements. And by removing that, all we're saying is that we will still consult with you because we know we have to, but it doesn't add an unnecessary burden in statute that doesn't match our OPR regulations for our scope of practice. In closing, this is technical and clarifying. This is not an expansion of practice. It's to improve data accuracy, support workforce stability, and reflects the care that is already being provided and effective throughout the state of Vermont. We thank you for your time this morning for

[Sen. Virginia "Ginny" Lyons (Chair)]: entertaining questions. Thank you, this has been very helpful. Questions committee. Senator Gulick has questions? I'm gonna go to you first because you're

[Devon Green (Vermont Association of Hospitals and Health Systems)]: a big one.

[Sen. Martine Larocque Gulick (Vice Chair)]: No, I'm good. Thank you for the testimony.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Senator Morley. I

[Sen. John Morley III (Member)]: hear this a lot. I'm new to the committee. Scope of practice. Explain that to me. How does that work?

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: Sure. So scope of practice is what your education educates you to do for your particular license. So for me, as an advanced practice registered nurse, my scope of practice as a primary care advanced practice registered nurse, which I'm dual certified, is all education around how to take care of a patient in the community. It includes the three P's, which is your pharmaceuticals, so multiple classes on how to prescribe medications. It includes pathophysiology, so the process of how a disease process is anticipated to work. We all know people don't follow books. What's my third P? Patho, no. Pathophysiology. Patho pharm, I'm a few years out of state.

[Sen. Virginia "Ginny" Lyons (Chair)]: Pathopharmacology, thank you. Thank

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: you. And then in the acute world, because I'm certified there also, I back to school and got a second degree for acute care certification. In my scope of practice for that, it's taking care of acutely ill patients with a completely different pathophysiology and pathophysiology education directed at the patient that is acutely ill. What would not be in my scope of practice is going into the Operating Room without a co attending surgeon and operating on a patient. That is not in a nurse practitioner scope of practice. So

[Sen. John Morley III (Member)]: we're trying to get your scope of practice to fit into the I'm sure physicians have their scope of pra everyone's got their scope of practice, basically. Correct. And trying to meld them together to make sure that you get

[Sen. Virginia "Ginny" Lyons (Chair)]: So No. So wait. Let's let let's let do you wanna say something, John, or not? Go ahead. I was gonna yeah, we'll let this go on for a little bit more, but we'll get the office of professional right away. I

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: was just gonna defer

[Jennifer Carbee (Office of Legislative Counsel)]: and we'll have the board of

[Sen. Virginia "Ginny" Lyons (Chair)]: medical practices.

[Jennifer Carbee (Office of Legislative Counsel)]: OPR has some testimony on your website today that goes into the scope of practice for But, I would just

[Sen. Virginia "Ginny" Lyons (Chair)]: say they do have, they're not here, but they do have, there is testimony. I didn't see their testimony. It's under Jennifer Colon. Okay, got it. Just briefly, hospitals define the scope

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: of practice that the hospital is comfortable with when they credential the provider. Okay, so when I am credentialed by my hospital, I apply for this skill, that skill, the other thing, I can admit, I can discharge, I can do this procedure, I can do that procedure, but if I wanna do these things, I am required to consult, collaborate, or refer. It's in my credential. So the hospital holds me accountable to my scope of practice. Okay. Which is legally defined by the OPR and my license.

[Sen. John Morley III (Member)]: I thought OPR was gonna define that, and it was the same all over the system. You're telling me hospitals.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: Yes, so something that I'm credentialing. It's the credentialing process of each individual hospital. So it is possible that I might be able to do something at one hospital more independently than at another hospital because that is the way the hospital wanted it. Okay. And this bill does not affect, address, nor is it relevant to that process.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Okay.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: Scope of practice is a different conversation from these language changes. These language changes do not change scope of practice.

[Sen. John Morley III (Member)]: Okay, I just hear the law.

[Jennifer Carbee (Office of Legislative Counsel)]: Yeah, you do and it's easily confused.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Okay. And

[Sen. Virginia "Ginny" Lyons (Chair)]: it'll get clearer and clearer when we have OPR and the hospitals come in.

[Jennifer Carbee (Office of Legislative Counsel)]: Jen, do you want me to add a little clarification as well? Yes, so again, referee, Office of Legislative Counsel. I think the only piece I would add, I don't disagree with anything that witnesses said about the bill, is I think the, as I understand it, the purpose of the bill is to really reflect the existing scope of practice of APRNs in language that currently only refers to physicians, even though the APRNs are authorized to do the things that the bill would recognize that they do.

[Sen. John Morley III (Member)]: Thank you.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: That was a very clear statement. Thank you.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: She's good.

[Sen. Virginia "Ginny" Lyons (Chair)]: She is, yes. And so, right, and we'll have questions as we go forward with oversight and relationships between and among different types of practitioners. Becomes important too. Okay. Any other questions for our guests? Thank you. This has been terrific testimony. And we don't have any other testimony this morning, so you find the seat. And I'm going to ask, I know that Vaz is here and I know BMS is here, Vermont Medical Society and the hospitals are here and we will pick your testimony up another day. But we have a few minutes right now if you want to say anything at all at this time.

[Jessa Barnard (Executive Director, Vermont Medical Society)]: Jessup Arnaud from Mathematics Society. I'll just say we are still gathering member feedback. We have definitely heard significant feedback and conversation, but our board specifically had set aside some time on the board to discuss this, so I don't have an official for you as of today. Thank you for allowing us to come back at a later time. Okay.

[Devon Green (Vermont Association of Hospitals and Health Systems)]: And Devin Green, Vermont Association of Hospitals and Health Systems. We're in a similar position of gathering information from our members, and we have a Chief Medical Officers meeting on Monday, February 2, and actually outside in the hallway, I invited Michelle Wade to come and speak at that, and so we'll have more information after that meeting.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so when that happens, then we will be scheduling additional testimony on this from the Board of Medical Practice, OPR, and then you folks, VMS and us. Hopefully there'll be a conversation outside,

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: my favorite place.

[Sen. Virginia "Ginny" Lyons (Chair)]: Can get something accomplished. I know that when OPR was in initially, and as I said, we will have them in again, they did ask to have sentence struck that's on page two that you identified. Thank you. All right, any other questions? Okay, so that's it for today. But Jen, after we've heard about this, do you mind going through it one more time with us? Because I don't think it hurts. Sure, Clista, can

[Jennifer Carbee (Office of Legislative Counsel)]: I get a Zoom link and I'll put the language up and we

[Sen. Virginia "Ginny" Lyons (Chair)]: can look at that? That would be great. That would be great. If we have time to do that, we'll take a little deeper dive. This committee did have a chance to visit Gifford, not this committee, but some of us a few years ago. It's a great place to be.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: We would love you to come back again. We

[Sen. Virginia "Ginny" Lyons (Chair)]: will, we will. We're thinking of places to go for field trips, so I've got it. And you know what, while we're at kind of a time, wait time, I just would like to say how appreciative I am in particular for the work that nurse practitioners do, ABRNs, all nurses in fact. This weekend was a terrible time. And it was really sad. On Saturday. That someone who had committed his life to saving people was so horribly killed. We appreciate that. That undid all the happiness and happiness.

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: While we're getting that link up too, I would invite the committee to join us for breakfast in the cafeteria next Tuesday. We'll be here for our lobbyists.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, good. Thank you. Alright. So we will share So as we start going through this and marking the bill up, because this will be a little deeper dive, If you want a copy of the bill, let Alyssa know. I keep going. Should be. Yeah. There's something in the box inside. Right. It's in that box there that

[Charles Martin (Deputy Secretary, Vermont Agency of Natural Resources)]: has By

[Sen. John Morley III (Member)]: the woods?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Yeah.

[Sen. John Morley III (Member)]: Well, I'm trying to get it fixed. Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: It'd

[Sen. John Morley III (Member)]: be nice to have one for Yeah, go on. Good to take the notes on

[Sen. Virginia "Ginny" Lyons (Chair)]: Take a minute, Bob. So we're stay live for a minute, and then

[Sen. John Morley III (Member)]: she shut.

[Sen. Virginia "Ginny" Lyons (Chair)]: Hopefully that everyone has an absconded world about it.

[Sen. John Morley III (Member)]: So did you work with

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Star Strong?

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: I know Star. I did not physically work with her.

[Sen. John Morley III (Member)]: With front of family. Favorite threat. Yeah. A legal.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Ready to go for this?

[Jennifer Carbee (Office of Legislative Counsel)]: Of good stuff to get you this week. So this is S163, an act relating to the role of advanced practice registered nurses in hospital care. In section one, again sections one and two, the context here is the Bill of Rights for Hospital Patients. And so the first thing it does is create a definition, add a definition for Advanced Practice Registered Nurse or APRN, and it refers to the subchapter under which they're licensed. So it's entitled 26. Chapter 28 is nursing. Subchapter two is specific to Advanced Practice Registered Nurses. Hospital keeps its definition patient, just changing from person to individual to be more specific given the broader definition of person in Title I. And then a physician is an individual licensed under 26 VSA Chapter 23, that's the MDs who are regulated by the Board of Medical Practice, or 33 for the Doctors of Osteopathy who are regulated by OPR. Those were definitions. Section two is the Patient's Bill of Rights, and it has the existing law, hence the General Assembly adopting the Bill of Rights for Hospital Patients as follows. It gives a long list of rights. Some of the changes here, just to remind you, are just changing gendered language to non gendered language, so instead of his or her, we just refer to the patient, or the patients. But in number two, the patient shall have an attending physician, this would add, or APRN is responsible for coordinating from A patient's care to D patient's care, that's not a substantive difference. This next sentence is the one that OPR and your witnesses this morning recommended taking out, which says physician consultation and support shall be available to an attending APRN at all times in accordance with applicable standards of practice and regulatory requirements. And as you heard from OVR, this would potentially be a narrowing of the existing scope of practice, which I don't believe was the intent of the bill, although obviously this committee can decide what your intent is if you move

[Sen. Virginia "Ginny" Lyons (Chair)]: the bill forward. So, question here. So, question then becomes that the notion that the hospital has bylaws that would regulate that relationship.

[Jennifer Carbee (Office of Legislative Counsel)]: I don't know if they're bylaws per se, but the hospital has authority. You know, and your witnesses are better to speak to this the hospital association than I am, but yes, they have credentialing requirements for them to allow an individual practitioner to practice in the hospital that may differ from the breadth of the scope of practice that is authorized by law in particular circumstances, but I will let them tell you more

[Sen. Virginia "Ginny" Lyons (Chair)]: of their witnesses tell you more about that if you'd like to. The

[Jennifer Carbee (Office of Legislative Counsel)]: patient has the right to obtain, and under existing law it says, from the physician who's coordinating their care, this would say from the physician or APRN coordinating the patient's care, complete and current information about diagnosis, treatment, prognosis, in terms the patient can reasonably be expected to understand. There's additional existing language about when an immediate family member or guardian can have the information, and then the patient has the right to know by name the attending physician, and again, Zwedad or APRN primarily responsible for coordinating the patient's care. Number four, except in emergencies, the patient has the right to receive from the patient's physician, this would add or APRN information necessary to give informed consent prior to the start of any procedure or treatment, or both, goes on about what that information for informed consent would look like, and some additional provisions that don't specifically use the term physician. That's why there's nothing additional added. So number five and six, I didn't change anything, there's nothing changing from existing law, we just skip over those with those three asterisks, or those who are new to reading legislation. Number seven is just a change to the gender terms, the existing right of the patient to expect that all communications and records pertaining to, this would change to the patient's care shall be treated as confidential. Number nine, the patient has the right to know the identity and professional status of individuals providing service to and it changes from him or her to the patient, and to know which physician, as in APRN, or other practitioner is primarily responsible for, and we're changing from his or her to the patient's care, and again, for the rest of this sentence, there's a couple of references to him or her, his or her care, and changing those to the patient. So that's the patient's right to know of the existence of any professional relationship among the treating professionals, as well as the relationship to any other healthcare or educational institutions involved in the patient's care. Number 11, the patient has the right to expect reasonable continuity of care, and to be informed by the attending physician, this would add or APRN of any continuing healthcare requirements following discharge. Number 13 is changing from his or her to the patient. Patient has the right to know what hospital rules and regulations apply to the patient's conduct as a patient. And then in B, we have failure to comply with any provision of this section may constitute a basis for disciplinary action against a physician, and under existing law it just refers to physicians regulated by the Board of Medical Practice, that's 26 VSA Chapter 23, So this would add or 33, that's the OPR, osteopathic physicians, or against an APRN under 26 VSA Chapter 28. And a complaint may be filed with not just the Board of Medical Practice, but also OPR as applicable based on the license held by the practitioner. Subsection C has slowed down here.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so I mean at some point it will be helpful to know the relationship between the hospital physician, the APRN. Does an APRN have this is a general question, think it's important, but I have to answer it. Would the APRN upon admission have the authority to say this person needs to go to surgery? Would the APRN have the authority to say this person needs to go first to ICU and following that to surgery or first to surgery then to the ICU? What is the level of authority that the APRN, what is the scope here for the APRN? How does it dovetail with what a physician can do, trying to get that sorted out? Because in here it looks like they're exactly the same. I think in

[Jennifer Carbee (Office of Legislative Counsel)]: this Bill of Rights, it treats physicians and APR ends the same as far as having an attending clinician who is responsible for coordinating the patient's care.

[Sen. Virginia "Ginny" Lyons (Chair)]: When we say coordinating, that's the word I'm after there, coordinating the care. An existing language. Can't you, I can't tell this will be

[Jennifer Carbee (Office of Legislative Counsel)]: Right, so I think you may wanna ask OPR these questions because they did testify that this was not an expansion of the scope of care.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, absolutely, I understand. I mean, it's a hospital. My PCP right now is an APRN. Before that, it was an empty I've rarely been in the hospital, but I've never seen my primary care provider in the hospital. I see whoever is on rotation at that point and I'm never sure who's in charge, And I wouldn't see this being any different than the rules that were you know, other than scope of practice, the rules that we guide an MD once the patient is in the hospital. Oh, great. So that that's that's kind of the way I'm looking at it, but then it's the hospital that's making a decision about who and how.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: What you need to clarify?

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: I shall wait for the record. I would give you an example and see if this helps clarify. I recently admitted a patient from the emergency department who I felt had appendicitis. That patient needed to go to the Operating Room for their appendicitis. I consulted my general surgery team who came and saw the patient in the emergency room. A decision was made that that patient was stable enough to be admitted to hospital medicine to me to come to the floor and be taken to the Operating Room the next day after receiving some antibiotics first. So collaboratively, the decision was made between myself and the surgeon. Subsequently, the patient went to the Operating Room under the care of the surgeon, then came back to the floor on my service under my care to finish out the recuperation and collaboration with the surgical team.

[Sen. Virginia "Ginny" Lyons (Chair)]: But you were still the person on the wristband and you're still the person in the records so that there was administrative simplification and flow through. Didn't have to shift it from one person to the next.

[Jennifer Carbee (Office of Legislative Counsel)]: So can I clarify based on the language in the team here, would you have been considered the attending APRN responsible for coordinating a patient's care? Yes. Okay. So that's what this is saying the patient has the right to that, but in practice that is what happens. It's not reflected in the bill of rights.

[Sen. Virginia "Ginny" Lyons (Chair)]: Then there's the other question that always looms in the back of our minds and that is the realm of liability. So what is the liability for the APRN under this situation including post surgical events? That's the question.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: May I speak from a maternity care scenario? I'm sorry, didn't

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: hear you.

[Jade Kaplan (Vermont Affiliates of the American College of Nurse-Midwives)]: May I speak from a maternity care? Yes, please. A certified nurse midwife emits a patient in labor. The labor goes along and runs into trouble. So the credentials that the nurse midwife has in her hospital, credentialing, delineation of privileges, okay, when you get to a situation like whatever's going on too long, baby's not happy, something like that, you must collaborate, consult or refer. So I call my OBGYN, I say, this situation is no longer entirely normal. We need medical input. I need a consult. Come and look, come and see, talk to the patient. I introduce the physician, if they haven't already met, to the patient. The physician renders their surgical or medical opinion. This lady needs a cesarean. I don't call this cesarean. I'm consulting, I'm collaborating, and now I'm referring. I am still the attending and the admitting provider. The patient goes and has her cesarean. I might go and even be a surgical first assist if my credentials include that, which at my hospital they do. And then once the patient is two weeks post op and has finished her surgical follow-up, she returns to group of free care if that's appropriate. Sort of how it flows.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Think she's

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, already applied think so doesn't get to my question, and this isn't a question for you necessarily as much as for everyone, including OPR, Board of Medical Practice, and our liability insurer. Who is liable for the care? If you're the attending, I mean, so this becomes for me important to know. It's probably already resolved somewhere out there in the legal world, but we just want to make sure that we're doing the right thing forward, That's

[Michelle Wade (President, Vermont Nurse Practitioners Association)]: a very important question, Madam Chair, and you are right to ask it. It is the attending of record is responsible irregardlessly of who that attending is.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yes, that is an issue.

[Jennifer Carbee (Office of Legislative Counsel)]: I think that was Senator Benson's question the first time we walked through this,

[Sen. Virginia "Ginny" Lyons (Chair)]: is who has the liability? So I think it's up to them with that. So then we've asked this question before because we know that the liability insurance cost for appending physicians is sky high, huge. I don't know what it is for APRNs. And I don't know what it is for an APRN working in a hospital that allows for your full scope of practice and those that don't. So there's a lot embedded within this that I think is important to APRNs and also to the hospitals and attending physicians. Why do we ask these questions? All right, go ahead, Jen.

[Jennifer Carbee (Office of Legislative Counsel)]: So take us back to where we're So we had gone back in a little bit to look, but we had gotten through section two. We're on page five. Yes, on page five, and page five is amending the statute on the requirements for a hospital to be licensed. So under existing law, under receipt of an application for a license and license fee, the licensing agency, which is the Vermont Department of Health, shall issue a license when it determines the applicant and hospital facilities meet certain minimum standards. Two of them are relevant here, I believe, because they refer to specifically a physician. So now we would have all patients admitted to the hospital shall be under the care of a, and not just state registered and licensed practicing physician as defined by the laws of the state Vermont, or getting more specific, under the care of a physician licensed pursuant to those two chapters in Title 26, or an APRN licensed under the sub chapter for APRN licensure.

[Sen. Virginia "Ginny" Lyons (Chair)]: Another question that I have, and this is for OPR probably, and we know that physician assistants are under the direct supervision of a physician. Are APRNs also under the direct supervision of a physician?

[Jennifer Carbee (Office of Legislative Counsel)]: Not after three, I think it's three years, three years in the practice? It takes two years, sorry. After two years, there's two thousand four hundred hours of supervision when collaboration, new grad, like a bridge into independent practice. And then they can practice independently in a

[Sen. Virginia "Ginny" Lyons (Chair)]: way that is different from physician assistants under the statute. Okay. And then that, that's after two thousand four hundred hours, two years? Two years and two thousand four hundred hours. Oh, god, thank you. And

[Jennifer Carbee (Office of Legislative Counsel)]: then under existing law, it really does not change. All must use the Uniform Credentialing Application form described later in this chapter. And then also one of the requirements for hospital licensure is that professional case records must be compiled for all patients and signed by the attending current law says physician. This would add or advanced practice registered nurse and continue the requirement that they be kept on file for at least ten years.

[Sen. John Morley III (Member)]: Well, basically, it's definitions, great changes. Mhmm. And one big sentence sounds like in the patient bills of rights.

[Sen. Virginia "Ginny" Lyons (Chair)]: But the one big the one big

[Jennifer Carbee (Office of Legislative Counsel)]: new sentence is the one that Right. Come out.

[Sen. John Morley III (Member)]: And then the rest is just his or her patients are the most of it and adding APRN.

[Jennifer Carbee (Office of Legislative Counsel)]: It's really adding APRN anywhere a physician is mentioned in the hospital patient bill of rights and the requirements for hospital life seizure.

[Jason Batchelder (Commissioner, Vermont Fish & Wildlife Department)]: Yeah.

[Jennifer Carbee (Office of Legislative Counsel)]: And I only mentioned a couple of times, so it's

[Sen. John Morley III (Member)]: But those are the big things.

[Sen. Virginia "Ginny" Lyons (Chair)]: Those are the big things. All within the existing scope of

[Jennifer Carbee (Office of Legislative Counsel)]: practice, but not reflected in the hospital patient bill of rights or the requirements for hospital licensure. Yeah. That's what I was telling you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Essentially, nothing's gonna change but that thing that gets stuck on the wall, a

[Jennifer Carbee (Office of Legislative Counsel)]: very fine print that no

[Sen. John Morley III (Member)]: one reads.

[Sen. Virginia "Ginny" Lyons (Chair)]: You're gonna

[Jennifer Carbee (Office of Legislative Counsel)]: have to reprint all the hospital patient bill of rights.

[Sen. Virginia "Ginny" Lyons (Chair)]: Say that because I saw it in there the other day while I was waiting for my husband. I don't see it every time.

[Sen. John Morley III (Member)]: So I'm working on that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So we've asked more questions than we've answered. Maybe not, but we have a lot of questions. We want to go through this with Board of Medical Practice, OPR, hospitals, and physicians. So, we've got all that testing we can. Right, and

[Jennifer Carbee (Office of Legislative Counsel)]: the Board of Medical Practice, I think, by virtue of who the executive director is also being the head of hospital licensure, it'd be helpful to

[Sen. Virginia "Ginny" Lyons (Chair)]: have the other girl and he speak that aspect. We haven't seen him in a while. No. Okay. It used to be a reasonable fixture.

[Sen. John Morley III (Member)]: Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: Questions for Jen or general questions that you would like to have asked, have the if you could get the questions that we will be asking folks, let me know. We can have Calista send that list off to anyone who's coming in to testify or offer repeat testimony. You've heard the questions, so this is important. Okay, well we have some time. We are going to go off live.