Vermont Legislature SmartTranscripts:

[Senator Virginia "Ginny" Lyons (Chair)]: Right. Yes, we're live. Terrific, thank you. This is Senate Health and Welfare. It's April Senate. I've been referred to our committee and come over from the House. So this morning we're going back to H-two 70 and we're going to hear from the sponsor for a quarter of the bill. Why don't you come on up? Thank you. Thanks for being here. Yeah, thank you for inviting me. Alright. I think you know everybody around the table. I think I do. Alright. Ann Cummings, Senator Ann Cummings, I'm not sure if

[Senator Ann Cummings (Member)]: was informally acquainted, but it's good to

[Senator Virginia "Ginny" Lyons (Chair)]: see you. I just I love the people that show is real focused. That keeps me from joking. Oh, shit. You. Every other senator, think I know. You. Teresa, all of you. So, you're part of my, I'm newly appointed, and so you're part of my education of how things work, you've crossover and bills. You've spent time on, already in the house committee, I'll send them, the House Health Committee, and seeing them land here. It's really interesting to see that process, it's nice to see the familiar bills here. Yeah, good, no, and that's exactly what we're doing. We're trying to familiarize ourselves with what you send to us. Yes. We make no promises on what happens to the bill after we hear about it. But what we look for from you is kind of the overview and what's the intent of the bill and what problem to solve. Well, thank you very much. This was the first bill I reported out, and it's a bill relating to the confidentiality for peer support folks that are first responders. And so they came to us. It was the committee on the initiative of the Vermont Service Provider Wellness Commission, and they said, This is the bill we need to help our folks that are helping you. We show up when things are at their worst and very desperate, and

[Senator Ann Cummings (Member)]: then we

[Senator Virginia "Ginny" Lyons (Chair)]: have consequences or debriefing that we need to handle. So they rush in when there's dangerous situations, and then they have to deal with the full impact of whatever may come across. So what this would do is it would provide the prompt, sort of no barrier support, of a trained peer, and do so, most importantly, protections of confidentiality. That's the piece that's been missing, that's what this bill really provides. And the question is, why is this so important for emergency service providers? Well, has to do with their culture. They are stoic, they have a fear of stigma, and they ask for help, and should they be doing that because they're no helpers? And they also have the fear that maybe their communications would be shared with a superior. So we did hear from folks in the superior position and they are supportive of this, but maybe not everyone would be. So we heard that it really helps for a person in this situation to speak with someone who really understands what they've experienced, to do so in a confidential setting, and that this would be a free account to them. We also learned that first responders change their own lives as a result of the work, the toll the work takes, than lose their lives in the mind we've used. So there are several ways this peer support might esteemed. It could be a critical incident debriefing. It might be an individual responding to a particular traumatized nature. And there's also the issue of cumulative and chronic stress that over time working in this sector have increased. And for all these reasons, they asked us to have this bill to help them. So I guess that's the gist of the problem it was trying to solve and where the cost came from. We heard from first responders, emergency department, police, secure care support team, all sorts of folks are actually just just waiting for this part of it. We ended up with some new definitions, the confidentiality protections, then in some areas where confidentiality wouldn't apply. So if you had if there was harm to the child, harm to himself, there's certain areas where the protections would fall away because the issues are too important to be unaddressed. Subject to HIPAA, it's protected from the public records requests, otherwise won't do it. So that's the gist of being. That's helpful. That's good. And what was the vote at a committee? And I meant to say that right at the top. It was eleven zero zero. Oh, wow. And we did work with it. It didn't, you know, it came to us in one form. Encrypt We heard from folks and we got it to a point that was, as you can see, very well supported by everyone. And reported out on the floor, and this is the Floor. I thank you. Pretty pretty straightforward. Five hours of treatment. Helps. Absolutely. So we've been working on this issue for a while, so it's helpful to see improvements going forward. Yeah. Great. Thank you. Yeah. Okay. Well, we'll probably take some time with it. Okay. Thank you for taking No promises. You know? Yeah. Well, make it better. Whatever. Right? Other than the fact that it's already Yeah. Thank you for for your work on it. And it's really

[Senator Ann Cummings (Member)]: I'll be tracking other bills.

[Senator Virginia "Ginny" Lyons (Chair)]: Terrific.

[Representative McGuire (first name unknown)]: You. You.

[Senator Virginia "Ginny" Lyons (Chair)]: That'll be fun. Thank you very much. Oh good. So we're actually two minutes ahead and Repentant McGuire is here two minutes ahead so that's great. We've got a couple other bills. Oh, and so I Are both of you reporting on February? No,

[Representative McGuire (first name unknown)]: just I am.

[Senator Virginia "Ginny" Lyons (Chair)]: Just the record. Okay, so that's great.

[Representative McGuire (first name unknown)]: All right.

[Representative Sonia Eastes]: I thought I was.

[Senator Virginia "Ginny" Lyons (Chair)]: Oh, are you the who's the reporter? I was the attorney. Okay. So then There

[Representative McGuire (first name unknown)]: you go. Sorry to reach out. Well, well, yeah, it's it's completely my

[Representative Sonia Eastes]: fault because I totally forgot that I recorded it. My first year, I didn't recognize the number.

[Senator Virginia "Ginny" Lyons (Chair)]: No, I'm not. I will be good. So we'll get Reverend McGuire back in or something. You're a sponsor. If you wanna stay or anyone

[Senator Ann Cummings (Member)]: I don't it's up to you guys.

[Representative Sonia Eastes]: Mean That'd be like, I'll I'll just I'll do it.

[Representative McGuire (first name unknown)]: Okay. So so alright. You take a break.

[Senator Virginia "Ginny" Lyons (Chair)]: Appreciate it. Okay. Well, it's good to have backup.

[Representative McGuire (first name unknown)]: Do want our. Okay. So

[Senator Virginia "Ginny" Lyons (Chair)]: we're looking at S I mean, H293. Yes. And the report of the village here represent, is it Estes or Eastes? Eastes. Eastes, yes it is.

[Representative Sonia Eastes]: Yes. Just the first four letters are like a direction. Yeah.

[Senator Virginia "Ginny" Lyons (Chair)]: So please introduce yourself, and then we like kind of the what problems you're solving and what's generally exhibited.

[Representative Sonia Eastes]: Oh, Jamie Gulick, guide me along, please. Thanks. My name is Sonia Eastis. I serve in Linden One. I'm from Guildford, and I also represented the. So h two ninety three is a proposal that came from the Department of Health last year. And it's just it's very small issues. One was it had three sections, four sections to build in. One one of the issues was just that the way reports were coming or the timing of reports with the department has asked that with a number of specific reports that they move from reporting every year to every three years in order to give them longer time lines for collecting data. So that was one issue. The second issue the second and third issue sort of worked together. There was a request from the Department of Health to be able to actually share certain confidential information as is, I guess, practice among other with other institutions around two issues, specific cancer registries and ALS registries, and, be able to share that, that research and also, be able to share databases, certain databases as other institutions are doing surveillance. So so we the house passed that bill. We we talked it through. Everything seemed as ordered. We talked it through, and then our committee passed eleven zero zero, and the as I recall, it was a voice vote, and so it passed.

[Senator Virginia "Ginny" Lyons (Chair)]: Terrific. So it's really alignment of reporting requirements.

[Representative Sonia Eastes]: Yeah. That's really on the list. A slight expansion of certain confidential registries, but I guess there's a

[Representative McGuire (first name unknown)]: practice out there that they're just working. Just a quick question on the sharing of data. Yes. Are they sharing the technical information for actual people's names? So no names are shared.

[Representative Sonia Eastes]: Maybe maybe it's a it's called a registry, but as I understand it, maybe you can help me here, but as I understand it, instances of situation. A person.

[Representative McGuire (first name unknown)]: Thank you.

[Senator Virginia "Ginny" Lyons (Chair)]: Representative McGuire, did you want to add any comments?

[Representative McGuire (first name unknown)]: No, just in regards quickly to the question, this bill also helps update the standards that are outlined within HIPAA to make sure all of that stuff stays in compliance. And it also, instead of the department having to report back or do a report every year, it's in and on out to where the report is submitted every third of you.

[Senator Virginia "Ginny" Lyons (Chair)]: Thank you. Okay. By chance, anything else? We're good. Thank you very much for coming in. Both of you. Appreciate it.

[Representative McGuire (first name unknown)]: Thank you. Good seeing everyone.

[Senator Ann Cummings (Member)]: Alright.

[Senator Virginia "Ginny" Lyons (Chair)]: Katie, here we are.

[Senator Ann Cummings (Member)]: Here we are.

[Senator Virginia "Ginny" Lyons (Chair)]: Good morning. Good morning.

[Senator John Benson (Member)]: So what

[Senator Virginia "Ginny" Lyons (Chair)]: I'm hoping is that this is the last really cold day that we have. I know it's like our jacket. Tomorrow's supposed to be yeah. Tomorrow's six. So, we'll walk through two ninety three. Okay. Then we'll go back to contaminated baby food.

[Katie McGlynn (Office of Legislative Counsel)]: Katie McGlynn, Office of Legislative Counsel for the record. Here is H two ninety three. This is a bill that the Housework Fund last spring. So, at the very least, we'll need a new effective date because right now it's July '20 So, doesn't work. So, a few different things. I believe these are all changes that were made at the request of the Department of Health. So you may want to have them in to provide a little bit more context. This first item in section one, there was an act that was passed maybe seven or eight years ago now that created a health equity advisory committee, and there were different health equity reporting requirements that were also part of that act. So this is amending in subdivision two, the frequency of reporting by the Department on Health Equity Data. As originally passed, it was annually. And now the request is every three years beginning in 2028. By January, the Department has submitted a report containing the results of the analysis conducted pursuant to subdivision one to the policy committees. What's in subdivision one? It's that the Department of Health shall systematically analyze such health equity data using the smallest appropriate units of analysis feasible to detect racial and ethnic disparities, as well as disparities along the lines of primary language, sex, disability status, sexual orientation, gender identity, and socioeconomic status. Report the results of this analysis on the department's website periodically,

[Senator Ann Cummings (Member)]: but almost

[Katie McGlynn (Office of Legislative Counsel)]: biannually. The analysis shall be used to measure over time impact of actions taken to reduce all disparities of the world. The data informing the department's analysis shall be made available to the public and apprentice of state federal law. So now, a specific result coming to the, or a consolidation of this information coming to the General Assembly would be every three years instead of every year if you were to accept this proposal. The next two instances of amendment do fairly similar things. The first pertains to the cancer registry that's in statute. The second pertains to the ALS registry that's in statute. I have to go back and check my notes on this because it has been a while since we've worked

[Senator Virginia "Ginny" Lyons (Chair)]: on this. Okay. This bill was started last year. Yes. Right. Yeah.

[Katie McGlynn (Office of Legislative Counsel)]: So it was not fresh in my memory. I'll go back to this change around written assurance, but both of the sections have language that in the case of researchers, this is about how information in the registry can be shared. There is a sentence, in the case of researchers, the commission shall also obtain written evidence of the approval of their academic committee for the protection of human subjects established in accordance with 45 CFR, part 45, 46. My understanding or my recollection is that this was struck because it only includes institutional review boards and not privacy boards. And that because of a change in federal law 2017 that excluded public health surveillance from, let's see, researchers doing public health surveillance can no longer get the IRB, the Institutional Review Board approval, so that's why it

[Senator Virginia "Ginny" Lyons (Chair)]: was necessary to include privacy boards in this exclusion. So I've been on institutional review boards, so I understand that. So what's a privacy review board?

[Senator John Benson (Member)]: I don't understand either.

[Senator Virginia "Ginny" Lyons (Chair)]: Okay. So maybe a distinction between the two. Sure.

[Katie McGlynn (Office of Legislative Counsel)]: So in statute, not in statute, but federal regulation that's cited here, we have language that a covered entity, so we're in HIPAA world right now, a covered entity may use disclose protective health information for research, regardless of the source of the funding of the research provided, provided that the covered entity obtains documentation that an alteration to or waivered or part of the individual authorization for use or disclosure of protected health information has been approved by one of two sources. So this is saying you can use protected health information for research. You can override the requirement that the person themselves has to waive permission to access the protected health information if you have permission from one or two entities. The first is the Institutional Review Board, which I do not have a definition of at my fingertips, but I can grab one. The second is a privacy review board that has members of varying backgrounds and appropriate professional competency as necessary to review the effect of the research protocol on the individual's privacy rights and related interests, includes at least one member who was not affiliated with a covered entity, not affiliated with any entity conducting or sponsoring the research, and not related to any person who's affiliated with any of these entities, and does not have any member participating in a review of any project in which the member has a conflict of interest. So this is a group of people with some professional competency in this subject area, hopefully per these regulations without a conflict in the research that's being conducted, that can give approval

[Senator Virginia "Ginny" Lyons (Chair)]: for the use of protected health information as part of an academic research So, academic institutional review board would have members of the research community, so it could be the psychology department, cardio, one other, other departments, physiology, whatever, looking at the research and then looking at how the data is being used from the human subjects and ensuring that it's done appropriately. And so privacy board might be, and that's hypothetical. I mean, could be from, suppose it's the heart association and they're affiliated with DOH and they're doing a, wanna do a study on cardiovascular disease and they're using data units. So they might wanna, they wanna access the data, but they have to have a review to make sure that that data doesn't expose subjects. So that kind of ethical consideration. Else you can help us with?

[Katie McGlynn (Office of Legislative Counsel)]: Well, so the existing language would just allow institutional review boards to have that waiver authority. And the request is to also allow privacy review boards pursuant to federal statute also have that authority in approving the use of this information in Vermont registries if, you know, for research purposes.

[Senator John Benson (Member)]: For some reason, feel squabbling about this, but I don't know why.

[Senator Ann Cummings (Member)]: Oh, no. No. Squirreling.

[Senator John Benson (Member)]: Because the individual doesn't know, I don't think, according to what you said, that the data is actually being used.

[Senator Virginia "Ginny" Lyons (Chair)]: So here's my suggestion. So how the data gets to the registry is also important. So it could be that the patient has already given permission for it to go to the registry, we don't know that. But we'll get the Department of Health in to answer the specific questions about how the data gets there and then how it's accessed further. Katie's gonna Every time you have a mammogram, they just stop. So I guess permission's on the computer now. They ask you a whole series of questions about your family history, and then they say, do you I have your permission to use it?

[Senator John Benson (Member)]: Yeah. That's not gonna just say.

[Senator Virginia "Ginny" Lyons (Chair)]: No. But that would go to some cancer research registry. Okay. Cancer somewhere. I don't know.

[Katie McGlynn (Office of Legislative Counsel)]: Is it all about the whole Wait.

[Senator Virginia "Ginny" Lyons (Chair)]: There's a whole there's a whole series of reporting patient information and access and we'd have to sort it out before we get too far down the rabbit hole.

[Katie McGlynn (Office of Legislative Counsel)]: We could look at the whole statute. You have an excerpt here. This is a whole section of law that establishes the registry, talks about in what circumstances a provider would submit information to the registry, what specific information is submitted. So we could look at all of that. This change that's happening, I don't think it necessarily addresses your concern specifically, but already there is language and statute that researchers, that the Commissioner of Health could allow researchers to have access to this data.

[Senator John Benson (Member)]: I did not know. I talked to him about that.

[Katie McGlynn (Office of Legislative Counsel)]: If an institutional review board approves that, and this just says, or a privacy board, this is just adding a different type of entity They're that could

[Senator John Benson (Member)]: opening it up even more.

[Senator Virginia "Ginny" Lyons (Chair)]: It's

[Katie McGlynn (Office of Legislative Counsel)]: a different type of federally recognized entity and the ability. My understanding, the Department of Health will I'm happy to stay in track with if this is wrong, but from my notes, there was a change in law in 2017 that, for whatever reason, made it so institutional review boards were not authorizing these studies to the same same extent as they were, which is why they want the privacy review boards to be able to. So here please hear from the horse's mouth because I'm probably not doing it justice.

[Senator Virginia "Ginny" Lyons (Chair)]: We'll we'll get we'll get

[Senator John Benson (Member)]: DOH in. Because HIPAA, they they mentioned HIPAA. The the representative did. They're not even

[Katie McGlynn (Office of Legislative Counsel)]: HIPAA required. This isn't HIPAA requirement. I mean, this is, like, big exemption. So what I read to Oh, exemption? Yeah. So this is HIPAA. There are exemptions in HIPAA where protected health information can be shared for various reasons, like law enforcement purposes, or we always talk about the duty to warn. If a psychologist, psychiatrist knows that their patient is going to charge somebody, that is an exemption from HIPAA where the psychiatrist warn somebody who could stop whatever's going to happen. So this is another type of exemption for research purposes. And this allows institutional review board or privacy board to review the research that's being proposed and weigh in as to whether protected health information could be used in that research.

[Senator Virginia "Ginny" Lyons (Chair)]: So, there questions here? This is good. There's more to it than changing dates. It's an attractive day at the heart. And we'll hear from the Department of Health about why this might be important. Did the change to add privacy board, was that in the underlying bill or that must have been added in the House? I think

[Katie McGlynn (Office of Legislative Counsel)]: that was in the language that they originally proposed. Okay. I mean, the was request of the health department. Yes, got it. I'm assuming this is the ask. I do think though, that they, where, I remember some back and forth about this language, the strike through. The commissioner shall first obtain from such state registries, agencies, or researchers an agreement to keep an agreement in writing to keep the identifying information confidential. I think the health department just wanted to strike this language and human services wanted something, written assurance is acceptable to the commissioner. I guess it's not always going to be a contract, the human services wanted something in writing.

[Senator Virginia "Ginny" Lyons (Chair)]: Well, however, we'll have to sort out the difference between a contract and a written insurance when data is being accessed from the profit health the bank. Okay. Alright. Anything else in here that you have questions about? I yeah. Well, I think the first big change we make is the effective date. Right. You know what I'm thinking? We have two more bills and the folks are scheduled. I don't Calista, is it possible for you to communicate with our two reporters and see if they are available earlier than 10:00 and 10:45. Because if we could have them in, we we can probably go through the bills a little bit faster now and give us a longer time a longer break. Okay. Yes. So, Calista, are you there? You have to be for food pills. I think we're gonna Hi.

[Katie McGlynn (Office of Legislative Counsel)]: Yeah. Sorry. I didn't know I was muted.

[Senator Virginia "Ginny" Lyons (Chair)]: No, no, you're good. You contact representative Stone and representative Rebecca and see if they could come in any soon before 10:00, both of them?

[Katie McGlynn (Office of Legislative Counsel)]: Yeah. I'll email them right now.

[Senator Virginia "Ginny" Lyons (Chair)]: How about okay. Alright. Well, email the committee assistant, please because they aren't gonna check their email necessarily. Do you want me to text them? Have their numbers. Sure. Alright, in the meantime, I think, Katie, I think we'll go through the bills that and we then they could come in and give us. Are we ready to do that?

[Katie McGlynn (Office of Legislative Counsel)]: Yeah, that's fine. $5.73 is a short bill, but I have some background information, so that might take a tiny bit longer. Okay, well let's do it.

[Senator Virginia "Ginny" Lyons (Chair)]: Let's start with which one, five thirty six. It's shorter if I do that. Okay. Yep. Okay.

[Katie McGlynn (Office of Legislative Counsel)]: Five thirty six, an act relating to toxic heavy metals, baby food products. We're creating a new sub chapter in the chapter on labeling of foods, drugs, cosmetics, and hazardous substances. This section that is being created has, sorry, I'm about to sneeze. No, I'm very dusty in here. Thank you.

[Senator Ann Cummings (Member)]: I think I'm okay. See, look

[Katie McGlynn (Office of Legislative Counsel)]: up here, sneeze goes away apparently.

[Senator Virginia "Ginny" Lyons (Chair)]: So this

[Katie McGlynn (Office of Legislative Counsel)]: act prohibits the addition of toxic ingredients in baby food products. It takes a tiered approach where infant formula initially is not included in the definition of baby food products, but it's included at a later date. There are some provisions that require testing by manufacturers of the baby food products to see if there are toxic ingredients in the product and there's also language that requires, like, a QR code. I'm trying to think of the right phrase. A QR code that consumer on the product itself, that the consumers could scan see the results of testing that's done by the manufacturer. Individuals can make informed purchasing decisions. So, definitions. Baby food product means any food manufactured, packaged, and labeled in a jar, pouch, tub, or box, sold specifically for babies and children younger than two years of age. And as I said, at the moment, this does not include infant formula. Final baby food product means the finished baby food product and not the constituent ingredients. Infant formula means a commercially available milk based or soy based powder, concentrated liquid or ready to feed substitute for human breast milk that is intended for infant consumption. Top of age two, production aggregate means a quantity of product that is intended to have a uniform composition, character and quality and is produced according to a master manufacturing order. Proficient laboratory. It's accredited under the standards of the International Organization for Standardization for the International Electrotechnical Commission. It uses an analytical method as sensitive as an analytical method described in the US FDA's Elemental Analysis Manual for Food and Related Products, and demonstrates proficiency in quantifying each toxic element to at least six micrograms of the toxic element kilogram of food through an independent proficiency test by achieving a Z score that is less than or equal to plus or minus two. QR code is the word I couldn't think of earlier, but don't need to

[Senator Ann Cummings (Member)]: go over the definition of

[Katie McGlynn (Office of Legislative Counsel)]: what QR code is. Representative sample means a sample that consists of a number of units that are drawn based on rational criteria, including random sampling, and intended to ensure that the sample accurately portrays the material being sampled. As used here, toxic heavy metal means arsenic, cadmium, lead, and mercury. Thank you. URL of the Uniform Resource Lodic Care and US FDA, the Food and Drug Administration. So, I should have said at the offset that other states have proposed and a few have moved forward with this language, or this language is based on language that has been proposed in other states. Okay. So that is where this is coming from. So first in B, a person shall not sell, distribute, or offer for sale any baby food product in the state that contains a toxic heavy metal that exceeds the limits established by the FDA, the provisions of this subsection shall not restrict the continued sale of inventory and stock before January. So, if shipment comes in on December 2026, that could continue to be sold. In subsection C, the manufacturer of a baby food product that's sold or distributed in the state shall test a representative sample of each production aggregate as a manufacturer's final baby food product rather than toxic heavy metals. Testing shall be conducted by a sufficient laboratory, which you know what that means because it's in the definition, at least once a month. A manufacturer of a baby food may test the final baby food product before packaging individual units for sale or distribution. Upon request of the Office of the Attorney General, a manufacturer shall provide some, the results of the test conducted pursuant to this section. So the agency's office can ask for the results of any product, that is baby food products that's being sold in the state, and that would be provided. In subsection Without requiring the provision of a universal product code or proof of purchase, a manufacturer of baby food sold or distributed in the state shall make publicly available on its website for the duration of the product shelf life of a final baby food product, plus one additional month for each baby product, food sold, manufactured, delivered, held, or offered for sale in the state, the name and level of each toxic heavy metal in the final baby food product if it's determined by the testing, sufficient information including the product name, universal product code, or lab, law or batch number to enable consumers to identify the final baby food product, and a link to the US FDA's website that provides the most recent guidance and information about the health effects of toxic heavy metals on children. So this would be on the manufacturer's website information about their testing results. In Subdivision 2, a baby food product that is sold online to a consumer in Vermont by either a retailer or directly from the manufacturer shall contain the product's webpage, on the product's webpage, a clearly labeled link to the information page containing the information that we just went over and see. I mean, in Subdivision 1. So, this information would be accessible on the product itself if you're in the store. Also, would be available on the website.

[Senator Ann Cummings (Member)]: In fact, Virginia.

[Katie McGlynn (Office of Legislative Counsel)]: Or the distributors. Either, it would either be if it's sold by a retailer or directly from the manufacturer. And subsection E, if the baby food product sold or distributed in the state is tested for a toxic heavy metal subject to an action level, regulatory limit, or tolerance established by the US FDA, the manufacturer shall display on the baby food product a label stating in a clear, legible, and conspicuous manner that more information about toxic element testing on the product is available by scanning the QR code, and a QR code or other machine readable code that directs the consumers to the manufacturer's website or the baby food product information page, providing the test results for the toxic heavy metal, and a URL to the webpage on the US FDA's website that includes the most recent guidance and information about the health effects of a toxic heavy metal. If a consumer reasonably believes based on the information provided on a baby food product that the product is being sold in a state in violation of this section. The consumer may report that to the Office of the Attorney General. And then we have this language in subsection G that we just looked at yesterday, a violation of this section is deemed a violation of the Consumer Protection Act, and it gives the Attorney General enforcement authority. Then we amend section two. We amend the section a second time at a later date. And at this time, you can see we're changing the definition of a baby food product to mean an infant formula, and we're striking through the language that says the baby food product doesn't include infant formula. So now infant formula would be subject to all of the language that we just walked through. There is a new subsection being added with the infant formula that the attorney general shall suspend the application of this section to infant formula if the AG verifies that there is insufficient infant formula in the state to meet the need. If the Attorney General suspends application, the AG shall post a notice on the office's website containing the specific dates that the suspension is in effect. And then I wasn't clear about the effective dates and that's because we have a contingent effective date in this bill. So everything that we've looked at in section one with regard to baby food products and excluding adding in the infant formula, that takes effect 01/01/2027. Section two, the adding in of the infant formula provisions, takes effect upon the AG's written confirmation to the speaker and the pro tem, which shall be posted on the General Assembly's website, that either California or two other states have enacted legislation with requirements substantially comparable to the requirements of this act regarding all of the following. The prohibition on the sale and distribution of infant formula that contains a toxic heavy metal exceeding US FDA limits. The required testing of infant formula sold or distributed in the state for toxic heavy metals, and the labeling of infant formula and the provision of information about toxic heavy metals and infant formula. So, if another two states or just California has an infant formula law that does these three things in a substantially similar way to Vermont as confirmed by the AG's office, then this would take effect.

[Senator Virginia "Ginny" Lyons (Chair)]: This last section dealt with one of my concerns. Whenever we've dealt these kinds of restrictions before, the danger is Vermont is such a small part of the market that we just if, fine, you want us to, you know, label it especially You're getting baby So food or generally, we tied it, like two other New England states and New York. California is a whole different market. It's the other side of the country. Where they're shipping it is closer to me.

[Katie McGlynn (Office of Legislative Counsel)]: I think I was not always in the room when they were talking about this. I think what you will hear them say is because California has such a big impact on the market that when California passes a law like this, manufacturers have to make the change, you know, for all of their products. And so that was why California was chosen. Would Actually, we look at New York. So Well, I I'm sure the sponsor New York usually does call in the just

[Senator Virginia "Ginny" Lyons (Chair)]: I wanna make sure because I'm assuming that this is over and above any federal FDA.

[Senator John Benson (Member)]: Right. That

[Senator Virginia "Ginny" Lyons (Chair)]: was my. I mean, to me, you're you're selling Right. My food with toxic materials in it, it's gotta be the degree that's different. So, yeah, the the California market does drive a lot of changes across the whole country. So Yeah. Everybody I'm less worried about that. Found to cause cancer in California. Yeah. So when we did the BPA, for example, we were the first day to do that. When we did other things, which one? Don't know. Inefficiencies, we didn't really follow California, a lot of this. Washing machines, Walmart Max. Well, so the point is it's a large group, it's tied to, let me ask a question, Senator. Katie, was your testimony about EU reach? Does the European Union have this type of Oh, they may have been, but Okay. So under the

[Katie McGlynn (Office of Legislative Counsel)]: This was during This was happening every day during crossovers. I will. We'll get information in out of lots of So Yeah. So And not

[Senator Virginia "Ginny" Lyons (Chair)]: You keep keep it all straight.

[Katie McGlynn (Office of Legislative Counsel)]: I am not throwing the funds

[Senator Ann Cummings (Member)]: to me on this, so.

[Senator Virginia "Ginny" Lyons (Chair)]: Okay, we'll sort it out. So, mean, that testimony, I know that this is a strong interest to some of our environmental groups and it's also a strong interest on the part of others who are concerned about sponsoring the babies. So we'll get folks in on this. We'll hear from Mary Katherine Stone who was I think reporter of the bill. No sponsor of the

[Katie McGlynn (Office of Legislative Counsel)]: Represented everybody else?

[Senator Virginia "Ginny" Lyons (Chair)]: Yes. Think I

[Senator Ann Cummings (Member)]: remember you. You're confirming. Good. Thank you. Okay.

[Senator Virginia "Ginny" Lyons (Chair)]: So we'll have Mary Katherine Stone has signed up to come in. When she comes in today, we'll listen to her. Okay. And then we have a lot of questions. There's no, I understand Senator Cummings question. California's way across the country, what effect will it have on us? And I do have a couple of questions. EU breach was one and then the other one is more closer to home and how do we deal with local manufacturers. Obviously they'll have to follow this requirement. We do have a local baby formula manufacturer in Franklin County. Yes. You may. I don't know if it's still there. I think Not there. I think they closed. Yeah. They did. Yeah. Okay. So those kinds of questions.

[Senator John Benson (Member)]: I still wanna understand the difference between what this bill was trying to do and what is already covered by federal regulations, because we're referencing the US Food and Drug Administration. So are we if that's what we're using as standards, then what is it that this bill is doing that has not already done? So

[Senator Ann Cummings (Member)]: Their standards might not be

[Senator Virginia "Ginny" Lyons (Chair)]: are what they got.

[Senator John Benson (Member)]: Yeah. 100%. That's the standard for reference. So it's not upsetting any difference.

[Senator Virginia "Ginny" Lyons (Chair)]: So we'll we'll see what the story is. And, Katie, maybe you could help us what at the last the sponsor will ask others to testify but in terms of what FDA requires and what this bill state is always allowed to take another step. Right.

[Senator John Benson (Member)]: And they are.

[Senator Virginia "Ginny" Lyons (Chair)]: I'm not sure. So we want to know what that next step is. Yeah. What what problem will be trashing someone? Well, we don't wanna kill this. But it's a big problem. I mean, are we saying that the federal regulations are not stringent. Yeah. That the federal regulations are allowing people to put Put cadmium out on the market.

[Senator Ann Cummings (Member)]: Yeah. Metals.

[Senator Virginia "Ginny" Lyons (Chair)]: It may be And they

[Senator John Benson (Member)]: are. Right.

[Senator Virginia "Ginny" Lyons (Chair)]: That's the point. I think that's what's implicit or Right. A lot of

[Senator Ann Cummings (Member)]: people That's just Hey, I need

[Senator John Benson (Member)]: to scan. It's nothing. So it's records without trying to figure out.

[Katie McGlynn (Office of Legislative Counsel)]: Good question. This is requiring annual not annual, but monthly testing,

[Senator Virginia "Ginny" Lyons (Chair)]: and it is requiring that the information be readily available to consumers. It's good for well, we'll You can make a choice about how much cat meal you wanna expose your infant to. Right. I remember

[Senator John Benson (Member)]: when girls were small, but they have little, little baby jars.

[Senator Virginia "Ginny" Lyons (Chair)]: Like I know.

[Senator John Benson (Member)]: They're gonna put all that information on, but the the QR code

[Katie McGlynn (Office of Legislative Counsel)]: is labels are tiny. Tiny. Yeah. You can't read

[Senator Virginia "Ginny" Lyons (Chair)]: them yet. Don't give it to my grandmother to me. Alright, so this is fun. I mean, Katie keeps opening up. This is good, we got lots of questions, we'll get folks in to testify, will help us, we have folks who testify in the house and we'll bring in them and others sort it out, get our questions answered. Okay, so let's go through, we're on a roll, we may as well continue and when Mary Katherine Stone comes in and Representative Rebecca will come in, we'll hear their testimony and we'll see how that sorts out. So let's go to five seventy three.

[Katie McGlynn (Office of Legislative Counsel)]: I was hoping to provide a little bit of background information about how somebody would get to a hospital involuntarily before we look at the language and 573. Is that an okay use of your time? Would you like to hear that before we jump into the language?

[Senator Virginia "Ginny" Lyons (Chair)]: Uh-huh.

[Katie McGlynn (Office of Legislative Counsel)]: I was thinking it might

[Senator Virginia "Ginny" Lyons (Chair)]: give more context to spread

[Katie McGlynn (Office of Legislative Counsel)]: the bill.

[Senator Virginia "Ginny" Lyons (Chair)]: Okay. So, I have

[Katie McGlynn (Office of Legislative Counsel)]: this slide that how somebody could find themselves at a hospital for psychiatric care. This forensic exam, those are people coming in through the criminal door. You know, you've already heard a lot about that this year. Somebody could come in voluntarily. And then we have these two boxes up above. There is a warrant and certificate for an emergency exam or an application and certificate for an emergency exam. So, we'll look at each of those in term, but basically, the application is what it sounds like. Somebody is observing that a person could possibly be meeting the statutory definition of a person in need of treatment, and so they are applying to have this person examined to see if they do need that hospital level of involuntary treatment. And then that would be paired with a certificate for an emergency exam. And those two things together would be what's needed to transport the person involuntarily to the hospital for an emergency exam. In the event that an application can't be completed in a timely manner, for whatever reason, there could be a warrant that a judge would sign off on in the place of the application, and that warrant and the certificate for the emergency exam would be what's needed to transport the person into the hospital involuntarily. So, these

[Senator Virginia "Ginny" Lyons (Chair)]: are

[Katie McGlynn (Office of Legislative Counsel)]: existing provisions that provide the groundwork for how to involuntarily transport a person. Okay. That first one we talked about the application. So the authority to transport and admit a person to a hospital for an emergency exam requires the application by an interested party and a certificate by a physician who is not the applicant. So a physician also has to weigh in.

[Senator Virginia "Ginny" Lyons (Chair)]: Application Yep. What is an interested party?

[Katie McGlynn (Office of Legislative Counsel)]: It's open ended. It could be the person's provider that they're seeing. It could be a family member. It could be a law enforcement officer or social worker that's working with the person.

[Senator Virginia "Ginny" Lyons (Chair)]: Yeah, someone to counsel anybody to go.

[Katie McGlynn (Office of Legislative Counsel)]: So, the application and certificate must state the facts and circumstances constituting the need for the emergency exam. And the emergency exam is sort of the step before there is a court process to hold the person in a hospital involuntarily. So this is just to get the person to the hospital for the emergency exam. And then the person is held for admission at a hospital for the emergency exam to determine if the person meets the statutory definition of a person in need of treatment, which means that they're a danger to themselves or others. It's a little more nuanced than that, but generally speaking. Then we have this alternative, which is the warrant. So, a personal observation by a law enforcement officer or mental health professional that the person's conduct constitutes reasonable grounds to believe that the person is in need of any treatment and the person presents immediate risk of serious injury or self to others if not restrained. The application for a warrant requires that there are emergency circumstances and that the physician certificate would be unavailable without serious and unreasonable delay. So, this court warrant, this warrant that's issued by a judge, takes the place of a physician having to weigh in as this physician has to do with a previous step. So this gets the person to the hospital for an emergency exam with a court order rather than a physician.

[Senator John Benson (Member)]: Even if they say, No, I do not want to come.

[Katie McGlynn (Office of Legislative Counsel)]: Yes, this is an involuntary process.

[Senator Virginia "Ginny" Lyons (Chair)]: Just an observation. It'd be so interesting to know or learn how much schooling or, you know, training law enforcement get in terms of how, like, mental illness presents.

[Senator Ann Cummings (Member)]: Because I just have absolutely no idea what kind of training they get.

[Katie McGlynn (Office of Legislative Counsel)]: There's that team too. There's the team too. Yeah.

[Senator Virginia "Ginny" Lyons (Chair)]: And they have been in to talk with us about the training they give at the Police Academy in Pittsburgh. And then we also have all the EMT training that goes on. We can get team two in. That might be a good thing to do. Haven't had them in a while. Just don't know I'm talking about the budget. Okay.

[Senator Ann Cummings (Member)]: Good question. This is

[Katie McGlynn (Office of Legislative Counsel)]: just to give you sort of background information because I think if you look at the language you'll be wondering what are we trying to do? So, is just sort of a chart to show you the steps that are taken before somebody is involuntarily committed. So, what we are gonna be talking about in the bill today is, can you see my mouse, is this area right here, this bullet. So, the authority to hold a person for admission at a hospital for an emergency exam can either be done with the application and certificate, or the warrant and the certificate. Assuming the person gets to the hospital for the emergency exam, the emergency exam is conducted by a psychiatrist as soon as practicable, but no later than twenty four hours after the initial certification. The psychiatrist does not certify that the person is in need of treatment, so the person doesn't meet the statutory standard, they're discharged. If the psychiatrist does certify that the person is a person in need of treatment, the person is held for seventy two hours. What happens in that seventy two hours? That brings us here. In that seventy two hour period, after the emergency exam, the hospital is terminated, hospitalization is terminated unless the person either voluntarily accepts to be admitted to a psychiatric unit, or the person doesn't voluntarily, doesn't want voluntary admission, then there is a court process that's initiated. That's an application for voluntary treatment that's filed with the court, and the court weighs in on whether the person can be held involuntarily for mental health treatment. We're not dealing with that in this bill. We're not dealing with the emergency exam. We're just dealing with this piece. So, it's important to note that the emergency exam is conducted by a psychiatrist, but when we're doing,

[Senator Virginia "Ginny" Lyons (Chair)]: let me go back to

[Katie McGlynn (Office of Legislative Counsel)]: this slide, when we're doing the application and certificate for an emergency exam, that certificate is done by a physician, not necessarily a psychiatrist.

[Senator Virginia "Ginny" Lyons (Chair)]: So, yeah.

[Katie McGlynn (Office of Legislative Counsel)]: I feel like you have a question.

[Senator John Benson (Member)]: So, any physician can do it?

[Senator Virginia "Ginny" Lyons (Chair)]: Yes. That's the current practice.

[Katie McGlynn (Office of Legislative Counsel)]: And now I'm gonna switch

[Senator Virginia "Ginny" Lyons (Chair)]: to the So, ED physician. Any physician. Any physician.

[Katie McGlynn (Office of Legislative Counsel)]: Yeah, that's good. For,

[Senator Virginia "Ginny" Lyons (Chair)]: I'll show you the language.

[Senator Ann Cummings (Member)]: Okay.

[Senator John Benson (Member)]: What's driving this amount of geriatric data is we're having issues on the individuals. Yes,

[Senator Virginia "Ginny" Lyons (Chair)]: yes. And we'll have the reporter give the overview, and then as we get testimony, it'll become So I'm gonna ongoing,

[Katie McGlynn (Office of Legislative Counsel)]: I'm gonna do this out of order. So, here's our statute on application and certificate for emergency exam. Gonna scroll down to the bottom where we have a definition of a healthcare professional, it's replacing the phrase certifying physician with healthcare professional. And a healthcare professional means a physician, an APRN, or a physician assistant. So that's meaning that, well first an APRN can already do what a physician can do under statute. So that is not a change. So if APRN is already conducting these examinations, what this would do would be to add a physician assistant, being able to certify on that application to transport the person for an emergency exam. So, a lot of words on the page, but that is really the thrust of what all the language does. So, expands that. It expands who can do a certification to transport.

[Senator John Benson (Member)]: There was three, Kate, there's an APRN, physician assistant, there's a one, Physicians. Previsions.

[Katie McGlynn (Office of Legislative Counsel)]: So the statute already says physician. We already have statutory language that says APRNs can do these tasks that a physician can do. So APRNs by default can already do it. So the practical effect is key aids are being added. I see that you have sponsors. Do you want me to pause here before we actually walk through

[Senator Virginia "Ginny" Lyons (Chair)]: the language? Let's do that and we'll hear from Representative Stone on the bill. We we actually started looking at the bill already because we have more time than we expected this morning. So it would be great to have you come up, and we'll put our heads back into a poor child?

[Katie McGlynn (Office of Legislative Counsel)]: I've been at the company. This is for people are struggling.

[Senator Virginia "Ginny" Lyons (Chair)]: So we went through the bill, but it would be helpful to hear from you sort of the problem that's being solved, the broader context of what's important here, and then go from there.

[Representative Mary Katherine Stone]: Okay, I am representing Mary Catherine Stone of Brownsville, for the record, and thank you for having me. I'm here to speak about H536. I want to start by sharing the why behind this bill, why it's so deeply personal to me, and why I felt compelled to introduce it here in Vermont. I first heard about this issue in this bill from my friend and colleague, delegate Michelle Maldonado of Virginia. She was speaking about a rare bi partisan win in her state in the Virginia legislature during a time of increasing polarization, and that alone caught my attention. I wanted to know what kind of bill could unite lawmakers across party lines in today's political climate. When I learned it was legislation addressing toxic heavy metals and baby food, I started digging deeper, and what I found was really alarming. Around that same time, I was pregnant and thinking really carefully about every choice I made affecting my child's health. And I was shocked to learn that even now in the current year, 2026, heavy metals like lead, arsenic, caffing up, and mercury are still found in foods marketed for babies and toddlers. As parents, we assume baby food is one of the most highly scrutinized products on the market, but the reality is that testing and disclosure are not consistently required and parents often have no way of knowing what is in the products they buy. My concern is not only personal, it's also professional. So for those of you who don't know, I'm a licensed and registered occupational therapist with significant experience working with children. I have worked in pediatric settings, including a NICU step down unit where I helped infants develop feeding skills. I have spent years supporting child development and partnering with families on nutrition and growth. And yet, even with that background, I did not know this was an issue until I started researching it myself. And that realization was really powerful. If someone with my training and experience was unaware, how can we expect the average Vermont consumer to know? That told me immediately that transparency itself is a form of consumer protection, and it's not theoretical. In my digging, I found that in Maryland, they passed a bill, similar to the one that is before you today, and it's called Rudy's Law. It was inspired by a child who suffered lead poisoning due to contaminated food pouches. That story underscores this issue, has real world consequences for real families. That exposure, even at low levels can affect neurological development, learning, and lifelong health outcomes. Unfortunately, that child, I mentioned passed away due to that exposure. Other states recognizing this, California, Maryland, Virginia, and Illinois have all passed similar laws requiring testing and transparency for baby foods, and these efforts have been bipartisan and grounded in public health, not politics, which is one of the main reasons I love this bill. They show that this is a workable policy and states do not have to wait for federal action to protect their residents. What this bill does is straightforward. It sets expectations for testing disclosure and transparency so parents can make informed decisions. It aligns with federal guidance while closing gaps that currently leave families in the dark. It does not ban foods, it does not vilify manufacturers, it simply says that when products are made for our youngest and most vulnerable Vermonters, we should meet a higher standard of openness and accountability. I've already heard from legislators in other states, well as our own advocates, medical professionals, environmental groups, families who are ready to testify. The Vermont Medical Society and others are interested in this conversation because they see the public health value. The breadth of support and the diversity of voices really reinforces what I believe really strongly that this isn't a party issue. It's not even a political issue. It is a public health issue. And at the end of the day, parents shouldn't have to be chemists or policy experts to feel confident feeding their babies. The least we can do is ensure they have access to clear information and that we are minimizing avoidable risks wherever possible. Our children here in Vermont do not advocate for themselves, so it is our responsibility to do so. And that is why I brought the bill forward, and that is why I asked for your support. And I can go through changes from how it was introduced to how it was cast, but that's the bulk of the This

[Senator Virginia "Ginny" Lyons (Chair)]: is terrific. That's perfect. Thank you. You answered a lot of questions that were asked before you came in about stakes that have already done this or would be doing it, so it's really helpful. What was the vote out of your committee? The vote out of the committee was unanimous. Inanimous, and then

[Representative Mary Katherine Stone]: And on the floor, one voice of opposition, and that was it. What was the pushback? The one person on the floor received an email from a manufacturer in Franklin County and they were worried, but that manufacturer's closing next year and we made that mistake because

[Senator Ann Cummings (Member)]: I'm That's

[Senator Virginia "Ginny" Lyons (Chair)]: the one I was asking about. Yeah. They're close before it would affect.

[Representative Mary Katherine Stone]: Yeah. Yeah. It it brought together some, like, pretty cool allies, I will say, in that house. Good. You know? So it was another good, like, bipartisan experience. See. We like that.

[Senator Virginia "Ginny" Lyons (Chair)]: Yeah. Yeah. Thank you for your work on that sincerely. Yeah.

[Senator Ann Cummings (Member)]: Yeah. I'll ask one.

[Senator John Benson (Member)]: Could I go back through the list of states that have been active Mhmm. Similar legislation?

[Representative Mary Katherine Stone]: California, Maryland, Virginia, Illinois.

[Senator Virginia "Ginny" Lyons (Chair)]: All right across the country. Yeah. Yeah.

[Senator John Benson (Member)]: Are manufacturers you making the changes? If they are making the changes, are they going to do it nationally? Once they start, I got to imagine.

[Senator Virginia "Ginny" Lyons (Chair)]: Once they start, they have to

[Senator John Benson (Member)]: That's what I'm guessing right now.

[Representative Mary Katherine Stone]: Yeah. Once they start.

[Senator John Benson (Member)]: So if they have started

[Senator Ann Cummings (Member)]: Right.

[Senator John Benson (Member)]: Changing it.

[Senator Ann Cummings (Member)]: Right. Okay. And

[Representative Mary Katherine Stone]: and, like, the idea of, like, oh my gosh. What if we and I do this and there'd be a shortage. None of these states have had shortages because the manufacturers may switch and then they're like not just gonna carve out the QR They codes for do it for every state. So, um-

[Senator John Benson (Member)]: So are you starting to see it in the state? Are you starting to see the QR codes off Yes, of

[Representative Mary Katherine Stone]: Rich, or sorry, Representative Richard Nelson did a little field trip on his own and he was sending me pictures from his local, you know, up in Durban, that he was finding QR codes on Fantastic. The back of baby

[Senator Virginia "Ginny" Lyons (Chair)]: good.

[Senator John Benson (Member)]: Yep, I can't read it. The

[Senator Virginia "Ginny" Lyons (Chair)]: the other question, did you hear anything about what the European Union is doing, EU REACH or anything related to their testing of baby foods? I think they talked about it

[Representative Mary Katherine Stone]: during, maybe briefly, but I don't think they've formally brought anyone in. I know they've more scrutinized in other places than it is here, which is wild to think. Yeah. I doubt that he puts Right. Exactly. They're made up and everything. Yeah.

[Senator Virginia "Ginny" Lyons (Chair)]: Any other questions for, Representative Stone?

[Senator John Benson (Member)]: Just want to know, are there other states that are looking at, enacting similar legislation?

[Representative Mary Katherine Stone]: Yes, and there are other states who are also looking at infant formula, and that's something that I also wanted to talk to. It's in the house version. They put an amendment

[Senator Virginia "Ginny" Lyons (Chair)]: on there. Yeah. We we saw it. Yeah. Good. It sends it out a little bit of time.

[Representative Mary Katherine Stone]: But Yeah. Yeah. It had some safeguards in there, but I would encourage to just for y'all to dig into that a little bit more to consider whether Vermont could take that step forward responsibly rather than waiting for others to go first. Like I said, the argument that manufacturers will pull away from Vermont after shopping with other states who have put forward, like, the baby food, they did it. I mean, the concern is real, but manufacturers have stepped up and changed their practice, and this is the conversation that's happening in other states. Yeah. Good. I just want y'all to

[Senator Virginia "Ginny" Lyons (Chair)]: think about that. Thank you. Yeah. We are thinking, though. Good. We're gonna

[Senator Ann Cummings (Member)]: look at it. And I would

[Representative Mary Katherine Stone]: have brought my little baby with me. That was my plan. But Oh. A four month sleep regression. Real.

[Senator Ann Cummings (Member)]: I sleep last night. But she

[Senator Virginia "Ginny" Lyons (Chair)]: would be Oh, I didn't sleep last night. That's not good. So, Oh. I haven't heard anything about not taking up any of the bills so far that we've been looking at, so we'll just keep going right along. Have one very large bill coming

[Senator John Benson (Member)]: to us that we're going look next week. It's just one that I need to get into.

[Senator Virginia "Ginny" Lyons (Chair)]: Oh yeah, we have information. We can't make decisions until we hear the You can't make a decision upfront. You never know what you don't know. We're gonna listen to Representative Rebecca on H573 and just so you know Katie did go through it with us a little bit. We haven't gone lockstep through it yet. We just got the introduction to what might be affected in here. What would be helpful for us is to hear your overview, what the problem is, and how to solve it.

[Senator Ann Cummings (Member)]: So you all know what is emergency evaluation? Okay. And you all know who we're talking about when we're talking about needing an emergency evaluation. These are folks who are in an acute mental health crisis, they're at risk of harm to themselves or others. Often, this is happening in an emergency room.

[Representative Rebecca (last name unknown)]: Unfortunately, that's sort of become the front door to medication healthcare for folks that are

[Senator Virginia "Ginny" Lyons (Chair)]: in treatment. We're trying to change the pathway. Yes. So maybe just talk a little bit about So, under Vermont law, the first

[Representative Rebecca (last name unknown)]: certification in this process of emergency evaluation, We're talking about involuntary, just to be clear. First certification authorizes the person to be held for emergency examination. Within twenty four hours, the psychiatrist has to indicate that we examine and certify that person, or the individual could be discharged. If the psychiatrist issues the second certification, the person can be called for up to-

[Senator Virginia "Ginny" Lyons (Chair)]: That's what we do. And then

[Representative Rebecca (last name unknown)]: they have to receive notice of written, written notice of rights, including access to remote legal aid, mental health care, so it's.

[Senator Virginia "Ginny" Lyons (Chair)]: So those safeguards,

[Representative Rebecca (last name unknown)]: of that's changed by this bill. I guess the higher, the overview is that EDs, again, are out front door, relate to psychiatric crisis care. This is not only destabilizing for patients, it's destabilizing for everyone who is working there and is not trained in how to support these folks who are in crisis, and it limits access to other folks who are there with broken arms, legs, etcetera. What we want to do is we want to sort of open up what is in some hospitals a bottleneck, because right now, APRNs and physicians are the only two hospital staff who can do sign off on the first certification. Oh, okay. I thought it was just physicians. Physicians in APR. APRN, This bill adds physician assistants who are in practice, most often they are actually the ones doing it. Frequently we heard, they do the first certification and then they wait for a physician or APR to come sign off on it. So this is really just reflecting what's happening in practice, and it's aligning that. Yeah. It doesn't eliminate the twenty four hour Psychiatric Psychic certification. So, we did have both rightfully concerned that this is making it easier to involuntarily convince someone. So, this doesn't do that at all. What it does is, again, it just makes sure that if someone, it gets someone to a psychiatrist faster and it gets them out of the emergency room where they're not getting the care that they need.

[Senator Virginia "Ginny" Lyons (Chair)]: So generally what the bill is doing is it's shortening the wait list, it's removing people from the ED who are better placed elsewhere and it makes sure that they're cared for in a more timely fashion. So I think kind of the way I look at Exactly. Here, you say. Okay. I can see where this group of people should begin counting. We've closed the psychiatric unit up here because I think we lost all our suspensions. That's an excellent question. I'm wondering if up in your area I mean, have we got psychiatrists available? Just as we'll get this with testimony, Senator, those are the kinds of I just want you to confirm any testimony. Yeah,

[Representative Rebecca (last name unknown)]: this is at the front end of the process, so we, yeah.

[Senator John Benson (Member)]: Yeah, it was the accessibility of it. I mean, if you bring that individual in the middle of the night, but it's twenty four hours, seventy two hours, but getting a psychiatrist there.

[Representative Rebecca (last name unknown)]: They do the second, yeah, they do the second exam.

[Senator John Benson (Member)]: Yeah. But you have let it go after twenty four. And if you can't get the psychiatrist.

[Senator Virginia "Ginny" Lyons (Chair)]: We didn't hear any, so we're going to, we'll take testimony, Senator.

[Senator John Benson (Member)]: Good.

[Senator Virginia "Ginny" Lyons (Chair)]: So right now, we'll just get the overview, but it's in here.

[Senator John Benson (Member)]: It was

[Representative Rebecca (last name unknown)]: pretty good. And this was very welcomed by hospital workers. Oh my I've already heard, I've heard.

[Senator Virginia "Ginny" Lyons (Chair)]: We've heard, this is good. No, thank you for introducing it. You introduced the bill, did you report the bill? And what was the vote in committee? Oh my

[Katie McGlynn (Office of Legislative Counsel)]: goodness. 11. I said last

[Representative Rebecca (last name unknown)]: time I came in here. Yeah. I believe it's less.

[Senator Virginia "Ginny" Lyons (Chair)]: And then toys are on the floor. Was it? Yes. Toys. That's good. No. It seems like a solution to a problem.

[Representative Rebecca (last name unknown)]: Useful. Yes. The other thing, and Kate probably let you know this, is that we did add into statute that anyone who does the first certification has to take a DMH offered training. I believe that wasn't in statute, but we're putting it there. We did a little housekeeping somewhere ago, that's gonna be whatever it takes, and I worked with representatives on

[Senator Virginia "Ginny" Lyons (Chair)]: Oh, and we'll hear from Katie going through the bill. She didn't she even sent it to me on

[Representative Rebecca (last name unknown)]: the floor. This bill. So I worked very closely

[Senator Virginia "Ginny" Lyons (Chair)]: with her. Okay. Yeah. Is. Yes. Chittenden got a question. Oh, Thank you for being here. What does the DMH training look like? Is that a like, an online training?

[Representative Rebecca (last name unknown)]: Or It's a manual. Yeah. I think it's it's I know there's at least a manual with it, I believe they shared it with us, and I can forward it to you if so. But they can talk to about the treatment. Thank

[Senator Virginia "Ginny" Lyons (Chair)]: you. Thank you for being available early. Yeah. We just we just run through all of our work this morning, and then she'll feel so So do appreciate it. And thank you for taking up so many mental health pieces. I think you also took up my mental

[Senator Ann Cummings (Member)]: health and AI, though. Mhmm. And then yeah.

[Senator Virginia "Ginny" Lyons (Chair)]: You may be back to give us the overview on that one, that would be good too. She's been going to there. Yes, but that's right.

[Senator Ann Cummings (Member)]: We're good. At the school reporters. Okay. If you haven't seen them.

[Senator Virginia "Ginny" Lyons (Chair)]: Yeah, no. Mental health has been on our agenda now for a few years, you know, so we've worked with the judiciary and competency, competency restoration, and we're working on mental health training for local EMTs, and this is all coming together. It's really good.

[Senator Ann Cummings (Member)]: And some of it's coming upstairs now, so thank you.

[Senator Virginia "Ginny" Lyons (Chair)]: That's good. You're getting it. Thank you. Thank you.

[Senator Ann Cummings (Member)]: Oh, yeah.

[Senator Virginia "Ginny" Lyons (Chair)]: So, Katie, you wanna check, go through with us? Not a long bill. Not not a lot.

[Senator John Benson (Member)]: So we're fast health care.

[Senator Virginia "Ginny" Lyons (Chair)]: So

[Katie McGlynn (Office of Legislative Counsel)]: I'm gonna start back at the top. I skipped ahead just so you sort of I feel like the punch line is at the end. The PAs are who can now, I think that's a But good maybe we'll start at the top. So there's this section 7,110, and as we were in the process of putting this bill together upstairs, there is language in this bill that is contrary to the process I just laid out to you when we were going through the process, the overview, and it's not the practice of anyone in the system. So so the proposal is to repeal it because it's not what is currently happening or what folks seem to think makes sense. So this language says that the certificate, a certification of mental illness by a licensed physician required by section 7,504 shall be made by a board eligible psychiatrist. And remember when we went through that overview, we said, well, the physician can do the, they call it the first service, and then the psychiatrist does the emergency exam. So, this is different than what is happening in practice, hence the proposal to get rid of it. And then it says in the areas of the state where board eligible psychiatrists, etcetera, are not available to complete the admission certifications to the Vermont State Hospital or its successor and interests, the commissioner may designate other licensed physicians as appropriate to complete the certification. So I think that's how we got to the point where physicians do it now. But now the practice is that physicians do it. So the proposal was to just repeal this section. Okay. That brings us to section two. And the first line brings us back to the comment or the question that Senator Benson had earlier, which is who is an interested party who can do this first certification? And you can see here that there, language is being struck out, and it's being replaced with a term of qualified mental health professional. So upon written application by a qualified mental health professional, so that is the person who could do the certifications. That's not a defined term in statute, but it is meaningful in the field as a term that's used with relative frequency. Upon written application by a qualified mental health professional made under pains and penalties of perjury and accompanied by a certificate, instead of by a licensed physician by a licensed healthcare professional, which we now know physician APRN PA as defined below, who is not the applicant. The person shall be held for admission to a hospital for an emergency exam to determine if the person is a person in need of treatment. The application and certificate shall separate the facts and circumstances that constitute the need for the exam, and that show that the person is a person in need of treatment. There'd be no changes. See, a lot of the changes in the first half of this subsection were sort of they weren't the point of the bill, but as we started walking through, we found that the language just felt confusing, so we tried to rewrite the sentence in a way that has the same meaning, but hopefully says it in a clearer way. So the new sentence is, admission of an individual to a designated hospital for care and treatment under this section shall be overseen by a head of hospital who may designate a person in writing to discharge the authority of this subsection. Prior to that, I had read, for the purposes of admission, an individual to a designated hospital for care and treatment under this section, a head of hospital, as provided by subsection A, may include a person designated in writing by the head of the hospital to designate the authority granted by the section. So That could be simplified. Yeah. So, the goal is to make that clear.

[Senator Virginia "Ginny" Lyons (Chair)]: What is a designated hospital? Designated person. Or designated hospital. Designated to receive mental health patients are only a few. I believe, and

[Katie McGlynn (Office of Legislative Counsel)]: we have DMH, correct me, but I believe a designated hospital are hospitals that could receive level one patients. Is that right?

[Senator Virginia "Ginny" Lyons (Chair)]: So designated hospitals are for involuntary hospitalization overall. So if you're in, can have to be an admissioner. And then level one is just for everyone. Thank you. So we'll have you come in and give us some thorough testimony on this plan. We'll have to sort out the distinction.

[Senator John Benson (Member)]: I'm guessing they're going there now.

[Katie McGlynn (Office of Legislative Counsel)]: They receive involuntary injections.

[Senator Virginia "Ginny" Lyons (Chair)]: They're showing up in the emergency room.

[Senator John Benson (Member)]: That's what they mean. So they're showing up there.

[Senator Virginia "Ginny" Lyons (Chair)]: But that doesn't mean they're designated to receive them involuntarily, which means they're sitting in for emergency. Correct.

[Katie McGlynn (Office of Legislative Counsel)]: So then we have this sentence that is really the whole point of this bill that the designated person must be an official hospital administrator. Oh, this is not the whole plan of bill. Sorry, we did that up above. But we're being consistent. A designated person must be an official hospital administrator, supervisory personnel, or a licensed physician on duty on the hospital premises other than the certifying healthcare professional versus physician, because now that's broader. As Representative Rebecca said, we have this training requirement added in subsection D. Prior to issuing a certificate pursuant to the section, a healthcare professional shall successfully complete a training developed and administered by the department and then be as used in the section, healthcare professional means a physician, APRN, or PA. This takes effect July '26.

[Senator Virginia "Ginny" Lyons (Chair)]: So we need to sort out the distinction between hospital, designated hospital, among other things, and then hear from folks who are directly involved, but we also want to hear from DMH on this

[Senator John Benson (Member)]: and all that helps. And what's it mean by the head of a hospital, is that the general manager of the hospital? Because I envision that can mean a couple different things, to be honest with you.

[Katie McGlynn (Office of Legislative Counsel)]: We sort of had the same debate upstairs as we

[Senator Virginia "Ginny" Lyons (Chair)]: were writing this. Who is meant?

[Senator John Benson (Member)]: Yeah.

[Katie McGlynn (Office of Legislative Counsel)]: Was that the house guy?

[Senator Virginia "Ginny" Lyons (Chair)]: Was it the head? Is it the chair of the board?

[Senator John Benson (Member)]: I don't

[Senator Virginia "Ginny" Lyons (Chair)]: know. I got the And the CEO.

[Senator John Benson (Member)]: Yeah. I don't

[Katie McGlynn (Office of Legislative Counsel)]: And the CFO. And Fox, I think, on the spot, sat down and and gave a quick analysis. You Okay. One more. Alright.

[Senator Virginia "Ginny" Lyons (Chair)]: The head of the on vacation. Believe so that

[Katie McGlynn (Office of Legislative Counsel)]: And the designation It can't be reached. They can designate this authority in in writing.

[Senator John Benson (Member)]: Right.

[Katie McGlynn (Office of Legislative Counsel)]: The authority discharge out. K.

[Senator Virginia "Ginny" Lyons (Chair)]: Anything else we need clarity on? So we'll have Vaz in. We'll have DMH in. We'll have AMS and the board of medical practice, I guess. No. They testify, sir. Oh, well, we'll look and see who testify. They don't need to go too far. Any other questions? You're gonna be busy? No. Short bills with absolutely no bills.

[Senator John Benson (Member)]: Yeah, is very easy. We're good. Famous last words. I know, appreciate it.

[Senator Virginia "Ginny" Lyons (Chair)]: Is simple. Especially healthcare. Yeah. We're good, I think. Just can you move the little guy. I'm sorry, I wanna know what Before to we go off, we can go off live, Calista.