Vermont Legislature SmartTranscripts:

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: You're live. Alright. Good morning. This is Senate Health and Welfare. It is May 13. The end is near, we think. Keep your fingers crossed. So this morning we're taking up some really important confirmations and we've asked the newest board member, Sarah Tichaud, to come in and talk with us about her interest in being on the board and maybe a little bit about your background as And then it doesn't need to be a long conversation, but we'll find out if you questions during that. Sure. Sarah Ticha, thank you very much. I am the newest member of the Green Mountain Care Board, and I really appreciate you having me in to talk about it. I think many of you, but not everyone, know me pretty well because I spent sixteen years in the Joint Fiscal Office working on tax and revenue policy for the legislature, which I think was good perspective and background about how we pay for things. The financing of systems is something I think I really bring to the board. And then after that, I spent eight years in government and media relations for Blue Cross Blue Shield for months. I think the health insurance industry experience also really adds to the knowledge base of the other portfolios.

[Sarah Teachout, Member, Green Mountain Care Board]: I heard that they've been appreciative and asked me questions. So, I think that's something my definitely will be bringing. You probably all don't know, but I did get a master's in public administration from Robert F. Wagner School of Public Service at NYU quite a long time ago now. And I was one of the University of Vermont graduates, so a little bit about that. I started last July with the board, so right before hospital budget hearings, the week before, so it was a pretty intense time to start, and I feel very lucky that I have followed the work of the board for so many years that I at least knew from the outside what they worked on. And I was a little bit up to speed, but there's certainly a lot to learn in the job. So, that was the most intense time at the board working on that. And then we also, and you've heard all this from other people, but we on the notice of service line reduction policy and held the hearing for Rutland Regional Medical Center, which was quite interesting. And I think we all learned a lot from that process. And I know you're still working to refine how we handle that. But that was really interesting. I've also been appointed to the liaison group with Mike Smith to oversee what's going on with the healthcare transformation at the University of Vermont Medical Center. That's been a very interesting process. I'm excited that we're having a hearing this afternoon where Mike Smith is gonna talk about the work with the group and the consultants that they've hired. So that should be, you know, really interesting, and I'm really hoping that I think everyone wants it to be very transparent, what's going on, and share as much with the public as possible, because it means so much to our health care system. I was trying to think of all the things we've been working on. Also, critical access hospital Medicare cost sharing issue has been something that we've all learned a lot about, trying to get up to speed on, and there's hearing also on that topic today, so it's a big day for treatment. And I think we're all struggling with, you know, having to protect patients and go to hospitals and move forward. So, I don't think we have solutions, but we're still looking at the issues. And then, I think you've heard all of this, but there's a lot more that goes on sort of behind the scenes at the board on the administrative side. So the hospital budget rule was updated, the ACO oversight rule and the ACO certification guidance, all kind of processes that it was helpful for me to go through at that ground level, so I feel more on dispute on those. We, of course, worked on the hospital budget guidance for this year, hospital 340B reporting guidance. We've gone through several certificate of need applications. So that's a process I wasn't as familiar with. And then we've been reviewing standard and non standard QHP plan designs. We updated the guidance on silver loading. You know, there's a lot happening in the healthcare space this year. So that's just, you know, the super hype, like what we've been working on and, you know, what I thought would be nice. I will sum it up by saying I really do enjoy working for the board. Personally, one of the things I like the most is all there is to learn. That makes the job much more interesting. And as well, you know, how meaningful every decision is. It's it's it's pro income. Of course. So and you all are super familiar with that. So that's is that brief enough? No. That's terrific. Thank you.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So glad you've got a little bit of who you are, and some of us have worked with you a lot Yes. In both your role in joint fiscal but then also with Blue Cross and Blue Shield. So appreciate that. So I'll open it up to questions and I'm gonna ask my question first. It's a simple answer I don't think but obviously the board is meant to be an independent organization separate from both the legislative and the executive branch. And in your experience since July, do you have a sense that the board is independent and do you believe that it should be independent? It's two things. Yeah. I think my answer would be yes to both those questions. Mean, from what I've seen and what I've experienced working at the board, I mean, all the board members and the staff really do view our role as being independent, nonpartisan, you know, attempting to to, you know, make decisions and and do the work for everyone in Vermont and not any particular interest group. And I think, you know, the board members themselves. I will also say that's one reason I've stayed kind of far away from this building this year. I felt like I personally needed to create a little separation, and I didn't want the perception that I was, you know, still involved in advocacy work on behalf of any party. So yeah. And I think it's important to maintain that, and that's something we need to constantly think about in our actions and how we handle the issues. Thank you. Questions? Committee?

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: I've one. So just by introduction

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Let me ask you this question first. Do you know anyone around?

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: That's what I was gonna say.

[Sen. Russ Ingalls]: I'm probably the only one. You are the only one.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Senator of York City.

[Sen. Russ Ingalls]: Yeah.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay. Yes. We worked together a long time ago. A long time ago. So sorry, Senator Benson.

[Sen. John Benson, Member, Senate Health and Welfare Committee (Orange District)]: I'm John Benson. I represent the Orange District. But my question would be, in your words, how would you sum up what the primary function is of the Green Mountain Chair Board?

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Yeah, so that's a hard one. In simplistic terms, I think we are really trying to look across the entire healthcare system in the state of Vermont and make it function better for everyone involved. And I mean the hospitals, the payers, and Vermonters who need the care. We're balancing all those tough issues, as you are as well, and trying to make the best decisions to move us forward, really, into a place I think we're in a really tough spot in healthcare right now, and so we're focused on affordability for certain, but we're also looking at the sustainability of the system. We wanna make it work for providers. We want to make it work for patients. We want it to be way more transparent than it is currently. And I think we share a lot of the same goals. Maybe the means could be a little bit different, but I think that's what we're doing. I have been asked, and I'll just put it out there a lot, like why does the board exist and why does Vermont need a Green Mountain Care Board? That's certainly something I think about. If our healthcare system is functioning perfectly, maybe the rule could be a lot more minimal. But it's not functioning well. It's really sort of a broken system and so we're trying to push different aspects of it to move us in a better place. And it's not just the board, it's everyone involved. One thing where I get confused is the responsibilities of the Greenout Care Board and AHS. They seem to get blurred, and I felt you stated. And I wish that there was some guardrails or something there because I get confused. Yeah. I think that others get confused too. And it's something that the legislature, I believe, has wrestled with several times, you know, moving different regulatory oversight rules from one to the other. It hasn't always been the way it is now. And, you know, I think that the Green Mountain Care Board is trying to stick to the regulatory oversight of the hospitals, the payers, and then the ACOs. You know, we have a lot of statutory authority over certain areas, and I know that AHS is really focused on the reform aspect, and there was an effort by this committee, I can't remember how many years ago now, to separate those two. And I think we're trying to stay within our lanes. But sometimes it's not always clear because all of these things impact the healthcare system and our intervention. I will add just one thing, and that is we have endeavored to put the word collaboration into every bill. And to last year or the year before, Health Reform Oversight Committee had a very intense meeting where we brought folks in together talking about collaboration. Your question is a really good one. Appreciate the tension that exists there. I have a question. You sort of touched on this already, but it is something that comes up occasionally for me as with my constituents and folks that I speak to who come to me complaining very loudly about the cost of health care in the state of Iran. But then in their next breath, they'll say, but we don't like any kind of regulation. And I I sit there and I I it's funny. I hear that quite often. So I'm wondering if you could just respond to that. I mean, I think that's sort of the nature of democratic society, really. Right? We all want our freedoms, but we we want it to work and function, which requires regulation. And, you know, I think as board members, we are always thinking about, like, how much is too much? Like, what you know, we wanna regulate the system, I personally think, with a light touch. But when it's not working, you need to And so I think balancing that is a constant process. And in every area that we regulate, a little bit differently. So the way we approach it with hospitals is a little bit different than we do with insurers and different than we're doing with ACOs and all of the different aspects the mental health system. I don't know if that answers it. Yeah. No. Think that's I always find it interesting questions because to me it seems fairly obvious, but everyone has a different angle. Yeah. Yeah. Thank you. Appreciate that. Okay. Other questions? Thank you. Thank you. Let me think of something really Okay. I know you're working on a million tough issues, so We are, but we appreciate the work that you're doing and we look forward to, you know, we'll hear back from you from time to time and know that you're integral to the workings of the board and know the experience that you bring to that board. How long was your term? Four and a half years. Probably filling out Robin. The end of the project. So that would be what? '20 what? Thirty? No. 2020. Somewhere in there. I can't remember. I would just look. But it's four and a half years from last July. Yeah. Plain I think '20. Something like that. Yeah. Sure. Okay. I can look it up and let you know. Yeah. That's fine. And then is there always the option to to renew or Mhmm. Okay. Yes. You don't have to go through the whole nomination process again. There's there's some there's some things you have to do. I know we modified the bill a couple years ago. I don't remember. Yeah. I don't remember either, but I have four and a half years. So It's in January, which is interesting. That's in that bill at the end of the bill with all of the updating on the nominating, committing and process, how long they have until before they're intending to leave, how much notice that is. I'm on the nominating committee but we tend to go very quiet unless there's something that's a good work for us to do. No, you don't go to work until there's a nominee Right. So, we'll see. Or, we actually met a couple of times when I was on it just to look at what needed to happen to improve the process. At some point, it would be good to hear your perspective on how to improve that process since you've been through it. Sure. Thank you. We just We don't need to get into Not right now. Okay. Thank you. Thank you very much. Appreciate it. Good luck. Thank you. Is Sandy coming in person or? I'll let Shane. Okay. Well, take about a couple minutes. May 15. Okay. Great. So I would ask for a discussion about Senator Gulick has brought Sarah Teach out in for to be approved and nominated. There's motion to send her confirmation to the full senate. I'll make a motion to send Sarah Chittenden's nomination to the full senate to the Greenmont Fair Board. Okay. Discussion? Yep. And you have her form. I think she's a strong candidate. You have my support here? Yes, I do. Alright. Okay. Let's do this. We should do this, I think, straw poll. I think we've always just raised our hands for the time. Yeah? You wanna do a full? That was a vote for the confirmation. Yeah. So I'm just gonna say all those in favor of confirming Sarah Teachow and sending to the full Senate for confirmation. Aye. Aye. Opposed? Okay, and we can, I think Senator Gulick will report this via underlined up on the calendar and I'm fine with your reaching out to senator Cummings for her vote because she's worked with her? Don't want to vote. Alright. Good. In the interim, I'm happy to talk about Gail Balk. Okay. You could do that one and then I have one as well.

[Sen. Russ Ingalls]: Oh,

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: good. So, let's let's start with Senator Gulick and then we'll go to Senator Benson. Actually don't have Senator Benson because this does not have all the information I was looking for. If you want to start, that's fine.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Thank you. So first one I have is Rick Hildebrand or commissioner of the Department of Health.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Let's start with that one.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: And he has indicated his desire to remain in that position, and has sent me, just an abbreviated bio, which indicates that he was appointed to commissioner of health by the governor in 10/13/2025. Before his appointment, he served several leadership roles at the Brooklyn Regional Medical Center, including Chief Medical Information Officer, Chair of the, our Medical Director of the hospital. He has also served as on the municipal boards, including the chair of board of medical practice. He earned his doctorate of medicine I don't know if you pronounce it. University College. College of Medicine and a master's of business administration from the University of Massachusetts.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: He

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: completed his residency in internal medicine at Dartmouth Hitchcock Medical Center and is clinical assistant professor at the University of Vermont's College of Medicine. As a practicing internal medicine hospitalist, Doctor. Hildebrand has been firsthand how social and environmental factors shape the health of Vermonters is experienced by him to pursue population health initiatives that address the border needs, broader needs of patients and communities. He is inspired by the collaboration work of nurses, public health professionals, administrators, allied health staff, policymakers, and physicians who share the goal of improving health of Vermont communities.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay, and we've had a, when we invited him in earlier in the session, we indicated that that would be his confirmation hearing and so now we have a little bit more about his background with fresh air memories and we know he worked with the Department of Health and Commissioner Hildebrand during the session. Are there any concerns about this appointment? None at all. Not here either. So, I would ask for a motion to send Mary Kilgoren's name to be confirmed by the full Senate as Commissioner of Health. I don't know if that function. I think

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: you need to repeat it all.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: All those in favor? Aye. Opposed? We're good. So we can deliver the top to

[Senator Heffernan (first name unknown)]: check trigulum. We're adding on to that.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: We called on to that. His name will be underlined in the calendar and then he'll be called up for confirmation and you'll give a floor report as you just did in here as to why sort of making that confirmation. So, it's board members, care board members, commissioners, deputy commissioners, secretaries, all underlined. Some of the ones we're doing today are normal. So I was one of the non underlined others, and actually she was assigned to Senator Cummings, but Senator Cummings told me to do this because she probably wouldn't be there. Okay. Gail Falk, who is one of the public members on the board about the practice, she's done five years already, this would be her second term. She works or worked for the Office of Public Guardianship. She has a child with developmental disabilities. She really loves the work and she's excited to continue. Okay. Any concerns? And senator Cummings Senator Cummings, like, Savvy Brady and. Correct. And then there's a Suzanne Jones. Did someone call her? Yes. She did. Okay. She went to. So let's do what's your first name? Gail. Gail Paul. Okay. Do you want to make a motion on that one? Sure. Do we have to do that for the nine? Yes. Okay. I'll make a motion to recommend Gail Hall to the Board of Medical Practice. A second. To the polls sign up for confirmation. All right. Discussion? All those in favor say aye. Aye. Opposed? Okay. What's the difference between the underlying ones and the ones that are underlying in the It's the of the leadership are underlined and the report on their background and why it's important to

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: And vote for

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: then the ones that are not underlined are taken together and voted on based on the recommendation from the committee of jurisdiction. Okay, Okay, so you pass on that one.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Right, so I have Susan Jones who is a physician assistant, a member of the medical practice board. She has indicated her desire to remain on the board, sent me her resume. She's a retired physician assistant with an active Vermont license and 30 experience in primary care. Experienced physician assistants, office and doctor Holmes of from 02/2024, physician assistant of the Mount Gordon Medical Practices, 2001 to present. Education is Yale University School of Medicine, physician associate program at the University of Vermont, MS, nutrition, School of nineteen ninety one, and Saint Lawrence University BS in 1987. Certificates and affiliations, licensed physician assistant in Vermont, NCAAPA, certified American Academy of Physicians Assistants, and the Vermont Academy of Physicians Assistants.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay. So we've got a physician, and then we have a PA. Both of those are important within the regulatory environment for the the board of medical practice. So are you do you receive a vaccine mandate?

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: I would make a recommendation or motion that we move the

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: vote Senate to remain on board of that for confirmation. Okay. Got you. Discussion? Questions? All those in favor, say aye. Aye. Opposed? Okay, thank you for your work on this. I know it's far in the midst of everything else, contacting people, talking with them, understands that perspective. Just in time. Okay. Just got to leave it. Good. Let me hear. Please, just get yourself settled. And let your feet. Yeah. It's more comfortable now that it's getting It is. Patting on that side. Yes.

[Sen. Russ Ingalls]: We have no idea what

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: that What

[Sen. Russ Ingalls]: that was.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: But. Is That historic chair. My. No. I'm not.

[Sen. Russ Ingalls]: Me see it outside.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So, Commissioner Hoffman, thank you for being here. I know you've been in our committee a few times and this is an opportunity for you to share with us a little bit about your background and then how your experience so far as commissioner and then maybe why you'd like to continue to be commissioner, what you see as sort of moving along to what are the biggest challenges you're facing. But it doesn't need to be long, just a very brief summary of your experience, where you are now, and what you see going forward. I know. Alright, experience. So I started in public service about thirty two years ago for the Department of Corrections. I was in college, getting a roping at, I took a probation and parole course and met Bob Smith from Corrections. He's like, oh, why don't you come over? So I applied and I was a correctional officer for just under four years. At the same time, was volunteering for battered women's services, so I was seeing the the violence, the domestic violence, and I was working with the offenders too.

[Sandy Hoffman, Commissioner, Department for Children and Families]: That's what they were called then. I don't know who they are anymore. But at that point, I was like, okay. I'm I'm coming in too late in the game. I wanna get in there earlier. So I started working at Woodside. I transitioned to Woodside and started working with adolescents with challenging behaviors. So I did that for about seventeen years. While I was there, I got my master's degree in social work, and then I got licensed as an alcoholic drug counselor. So I was working for FSD, and then I was doing an internship in the neonatal intensive care unit, and at Vermont Catholic Charities, where I did individual family and group counseling there, and then worked in a school as a social worker also. So those things were all happening at the same time. So I worked at Woodside for a while, and then there was a shift there that was it didn't align with my values, so I thought, well, let me see about moving. And at the same time, I was working on continuous quality improvement, and I did some courses in that, and I liked I liked measures. I liked assessing and evaluating programs. So then, there was an opening at the Department of Vermont Health Access, so I went over there and was the manager for the Clinical and Quality Integrity Unit, and then became the director of that unit, then it was called the Clinical Chief, and then Deputy Commissioner for the Department of Vermont Health Access. And in that role, I oversaw the data, clinical, quality, oversight and monitoring, special investigations unit, so like a wide breadth of services. It was really full for a long time. And then this position came up at DCF. And, and it's like coming home because I had started, you know, I started there and that's, I think, I really appreciate working with children, and I have that perspective, and there are a lot of things that are happening at DCF now that, that I can, can influence perhaps, and that's exciting to me that when I came on, it was right when the government shutdown happened, and it was a quick a quick move to get SNAP benefits to people who weren't getting benefits. And when I saw how great the team was doing that, the quick moves and figuring out how to make it happen, it just was so exciting to be a part of a team who can act so quickly.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: And then the passion of all you've met a lot of the folks that work at DCF. To work with such a team, it's just been an incredible experience for me. I mean, public servants across the board are awesome, but they're really great here, and I I really love the work. So, I think I covered everything in that. I think you did and with appreciation for how you did it. I do have one question and that is, so just share with us what you see as the two or three biggest challenges facing us right now within your environment. And I know It's really hard to pick of it, but I don't want to just pick past nine thirty eight out, so I'm sure that's That's not a big one. That's huge. Homelessness is huge. And then I think preventative care and foster care and Oh, yeah. You know, that are there therapeutic interventions that you can do early on, like, through foster homes, I think is huge. In the in the homelessness, of course, that counts. That's shelters. That's the GA approach. So that whole then benefits, ESD. So I think in just that response, covers a lot of priorities. Know in the CDD world, fingerprinting, getting the background checks turned around quickly, that's huge. And then updating the IT systems within across the department. Is the background check, is that getting figured out? It is a paper. Yeah. It's been a big issue. Yeah. Jennifer McLaughlin from CDB has been amazing. Good. Yeah. Oh, it's great. And IT is Yeah. All therapeutic. Yeah. Other questions for the commissioner? Is there anything that we need to know about your work or the issues facing you that we can help? How can we help besides not doing anything? I think culturally, there has been, not necessarily in this committee, but there seems to be some kind of almost adversarial relationships with some some we're all public servants, and we do this. I do this. My team does this. The folks at DVAI know that. HHS across the board. We do this because we care about people. And I think that's why you and this body, you know, everyone does it. If we all could just be more collaborative and not this committee, I'm not saying this committee. Well, have to remember, we put the word collaborative in every single one of our healthcare transformation Yeah, I love that. I love that. It's an And is so important across the board. Advocates from everywhere. We all are working toward the same thing, and sometimes we're at odds with certain pieces, but ultimately, we all have the same goal is to help Vermonters. Thank you. Thank you for that. Other questions coming in? No. It's we have worked with you this session and really appreciative of your help with the bills that we've passed. Yeah. Same. I gotcha. We don't have any difficult questions today. Okay. Great. We're really just fine with your coming in. Thank you for doing that. Okay, great. Great, we're all set. Thank you. Thank you. Thanks for having Have a great day. You too. You too. Oh. Sorry. Don't think that you're always going to get off this easy. I've become so for a minute. Alright. Take care. Thanks. Bye. Alright. Good. So this was your I don't know how he's landed on my desk, but yes, she I volunteered, Senator. I did? Okay. I will make a motion to approve the appointment, recommend the appointment. Somebody's whispering my ear. Ahead, you make the one No, go ahead. It's just to recommend to the full Senate that we Sandy Hoffman as Commissioner of the Department for Children and Families. Perfect. Yeah. There you go. Discussion? Okay. It's been because she has a really broad background that is extremely helpful today for what we're going through and working with the judiciary and public safety. It's great. I agree. Okay. All All those in favor of sending the Sandy Hoffman aye. Aye. Opposed? We're good and again we can talk with Senator Cummings. I will. That'll good. I mean, we're gonna take one more and then we're gonna move on because I know Senator Ingalls is here with his proposed amendment. I will hold mine till later. I have my own posture, so we can save that and we'll look at what Senator Ingalls has for it. Age six sixty, so Senator, thanks for being here.

[Sen. Russ Ingalls]: Thank you for having me, madam chair. It's my chair.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: And you, do you have copies? Well, I I was hoping here I can pass. Yep. Okay. So I've read it. Yeah. And you sent it to us very nicely.

[Sen. Russ Ingalls]: Yeah. Sent it. Yeah. I wanted you to get to be able to see it. I don't as a fellow chair, we do respect that it at least comes forward. I just got a funny story. The, previous witness, Ms. Hoffman, we have the same name and I spelled the same way, everything in our in our area. And when I heard that she was confirmed or I congratulated her, it kinda shocked me a little bit. It's a what else? Right. I did a. So I congratulated her. I carried it back. It wasn't the same person.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So so anyways, I I think that was

[Sen. Russ Ingalls]: yeah. Anyways Oh, you have a credit report. Yeah. Exactly.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So made someone feel really Yeah.

[Sen. Russ Ingalls]: Really good. So she's and I haven't been the only one that had congratulated her. So h six sixty, I think there is three quarters of in my own assessment, which is dangerous in time that I get it. I think that it's a a great bill. I did as I spoke out yesterday, I just think that there are some things in there that I would like to see changed, and what I have to propose to do is to take the $850,000 of the needle program and the $1,100,000 for the proposed idea in Burlington and to move it into recovery houses that are affirmed by the state. That's really all that I've done. I just believe that, you know, I've done some research, 45% of the nation is experiencing reductions in drug use now. Most of the states that are involved are not using the opioids, or not allowed to use the opioid settlement funds for anything but for true reductions. Most of them are going to recovery home, and I think that we are on the path in that direction, and I think it's time that we really we try to lead the nation so many times, in so many different directions, and I think that we could lead the nation in having people fully recover from addiction. So that's where it is. I appreciate your time. I appreciate allowing me to come in and present the amendment, and hope you take a whole lot of your time. It's pretty straightforward.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay, so thank you. So what this represents is, and Katie will confirm, this represents removing the $850,000 from the Syringe Services Program, the $1,100,000 from the OPC in Burlington, and placing it into recovery. Yes, that's it. Okay, and we'll see where that goes. I see it right there.

[Senator Heffernan (first name unknown)]: Okay, all right.

[Sen. Russ Ingalls]: Well, thank you very much. Thank you for taking the time. Appreciate Yeah,

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: thank you. We also appreciate your passion about continuing to reduce opioid addiction. We do appreciate that. Well,

[Sen. Russ Ingalls]: We appreciate this senator. Senator Morley and I have a great friend that passed away a year or so from Genshin, great friend. We grew up with her, grew up with a family, in a private her life. She won the battle in high school, but you never win the battle. And if you would

[Senator Heffernan (first name unknown)]: have said to her, Paula, we'll give

[Sen. Russ Ingalls]: you ninety days to be better and be cancer free, would you take that? And she would take that every time. And I think that most people would, but there is a, you know, most people are in, as you are very well aware of the church community, you deal with it, people are in denial that they're an addict. People are in denial about a lot of things in life. People are in denial that they're not healthy. People are in denial that they're too heavy. People are in denial that they have bad habits. And people that are addicted are denied the most, and they cause a lot of harm. People that have no source of income have a $1,000 a day drug habit, and that money comes from someplace, it affects homelessness situation that we have. I hate to throw out there, but a lot of those folks are addicts. And and I just think that we owe it to them and to Vermont to do all that we can do to make those hundred and seventy deaths down to zero, and that's my passion. Thank you. Thank you. Thank you for having me in. Alright.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So we've got two more proposals, one from Senator Heffernan and one from Senator Morris. And Senator Heffernan's is on Section 16. Of which bill? Six eleven? Six fifty seven. Yes. Six fifty seven. So we're gonna go to Senator Norris He's

[Senator Heffernan (first name unknown)]: a senior senator. All right. Good morning, Senator. Thank you

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: for being here. Good morning.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: The airlines from the record, Senator Bob Norris, Franklin County. Before you at the Gospel office this morning, there seems to be a less than controversy amendment. Controversial amendment. Basically, you heard my concerns yesterday on the floor, and I've got a few other co sponsors on here, but I guess I'll just dive right in. If you have any questions, I'd go to section six a, syringe recovery, honor report 12/15/2026, the Department of Health just about applying to the House Committee, Human Services and Senate Committee on Health and Welfare containing recommendations for the implementation of one or more syringe recovery models throughout the state to enhance public health and safety.

[Sen. Robert “Bob” Norris (Franklin County)]: The plan shall require syringe service providers to report to the department on the percentage of distributed syringes that are returned to the provider or otherwise collected. If I do this, that's simply nothing more, it's not gonna solve our concerns, but it's a starting point to start collecting that data, doesn't change anything in the bill, but I feel more comfortable if I start receiving data from these entities to receive the surrogates to pass them out. So that's my concern, if

[Sen. Russ Ingalls]: I express that on the call yesterday.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Yeah, and so the plan will have some way for syringe service providers to actually recover syringes from the Department of Health. Questions And about the proposed amendment. And we do have Department of Health up on the screen with us. I just said, you please go ahead.

[Sen. Russ Ingalls]: Well, Senator Norso, it sounds like

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: to me you're just trying to track. You know how many surgeries are going out, and then you're going be able to track how many have come back in through, I can't remember

[Sen. Robert “Bob” Norris (Franklin County)]: what it was called, they call it something, you drop the syringes

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Oh, the discharge, discharge. And

[Sen. Robert “Bob” Norris (Franklin County)]: so where's the differential going? Is that kind of what you're driving at here? Yeah. And and attempt to answer your question, I don't know how many of syringes are going out. No. I don't either. But if I if I did know that, and more importantly, I don't know how many syringes are coming back in. So as I said, we'll just find my ballparks and football fields, on my lawn and my driveway, I know we're not all going back. So I just wanna know what percentage you may not be coming back into.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: And so what we also don't know is that the syringes that are produced through the program and state are the syringes that are on the ground because a number of folks actually buy syringes over the Internet and they get them different ways. That's probably not so common, but it's also something that you've identified a little bit, knowing the number going out, and then they collect a number in, you know how many of theirs are left there. So it's how do they do that? That's the question.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Yes, and in response to that, I'd like to think that it's a small percentage of those syringe you find along roadside that may be purchased by these individuals and toss that onto the lawn because most of these folks need some help. And so they can't afford to buy these charges, so they go to this so called legal exchange program, I'm concerned about whether or we're actually doing the exchange within this program.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay, so what I'm going to do is I'm gonna turn to the Department of Health for a comment, and then we'll have Well, that'll be it. Sheila, thank you for being here.

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: Thanks for having me everyone. Hi, I'm Sheila Livingston. I'm the Interim Deputy Commissioner for the Health Department. So, the Health Department is not opposed to this amendment, but I just did want to let the Senate know about what we're already doing. So, this winter, fall

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: and

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: winter, with the Governor's work that he did with the city of Burlington, the Health Department was part of that work, and we did a revamp of the programming with syringe service programs around return rates across the state, not just in Burlington. And so we now have requirements in the grants for there to be a 95% return rate. So, we're building to that. We're not at that immediately. But that is what we're working with the grantees to get to. We do count that. We do track it. We are now having the programs report that by region. And we should have data by the time that the, this, you know, report or recommendation is being asked for. And we would definitely be willing and happy to share that with the Senate. Additionally, there are communities that have already started their own programs with our support around recovering syringes that are disposed in the community. Arlington is one of those. Barry was actually a leader in that work, and other communities are interested in that. We have toolkits for that and, you know, and training for how to do that safely. And lastly, would say, is really important that when we work with our clients who come into these programs, that the programs work with them to know and learn and understand how to safely dispose the needles if they cannot carry them back or bring them back to the site. So sometimes that is also dangerous. And so, you know, sending them with safe disposal kits or, you know, safety instructions on how to dispose them safely is also part of the work that we are doing with these programs. So, you know, really a new focus on that this late fall, early winter, really supporting the programs to enhance the work they're doing with clients. And again, you know, very much in alignment with the amendment, happy to come back and report on it, but just wanted to reassure the Senate that we are already working on this, and supporting the programs. The last thing I want to say, just so folks know, is that for prevention of the spread of disease, we really want to make sure that we're working with clients to have access to this. And so, while we want to support this and we are, we understand that the communities cannot continue to tolerate the level of litter that they're experiencing right now, we want to make sure that we do it in a way that's supportive so clients continue to come and get these important services. So, again, not opposed to the amendment, but, you know, already doing this work, happy to come back and report out on it.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay. Thank you for that. And I do know that the the program, the syringe service providers are providing education, they're providing sharps containers, there's a whole lot going on. They're providing testing strips for Xylazine and Sentinel, so there's a lot going on. And as you have said, there are programs that are already pilot. I do know that the Howard Center also had a program for doing this and they've ended that. But you're not opposed to this amendment because it seems like it will enhance the work that you're doing. That's a question.

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: I don't think it will enhance it, no, but it's in alignment with it.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: All right. Can I ask those two questions? Yeah, go ahead. Cheryl, when you say you're not opposed, is that the same as you support the amendment? Because I got in trouble recently when I conflated those two things. Okay. You support the amendment or are you just not opposed to the amendment?

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: I'm not opposed to it. I mean, we we are so happy to come back and and tell you all about this work and especially once we have more data next year. Do I need the amendment? No.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Right. And can I ask one other question? Sure. Can you really briefly speak to the fact that the needle exchange program reduces the spread of disease? Because that's not something that we actually talk about very often.

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: Sure. So, the genesis of needle syringe service programs and having syringes available to clients is to reduce the spread of infectious disease. So, you know, HIV is maybe the best known, but Hepatitis C is more common here in Vermont. There's all sorts of blood borne pathogens that can be spread by sharing needles in the active drug use. And so, when we think about ensuring reduced burden on humans, and improved health outcomes, providing clean syringes is a harm reduction method of reducing the spread of infectious disease. That is its primary purpose. That is where this kind of programming started and came from. And, you know, it's really, really still an important tenet of it. We have recently shifted these programs to be managed by the Division of Substance Use here at the Health Department, because we acknowledge that most of the sort of other problems being faced by these clients have to do with substance use. And so, there's a lot of other harm reduction services that these programs provide to clients when they walk in the door. The chair talked about testing strips, you know, referrals, Naloxone, education around using more safely. All of these things are important aspects of the program, and pieces that we really wanna make sure are in place for folks who walk in the door.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: We're good. We're good, Sheila. Thank you. Our time is really limited. We need to move. Just very quick question. Yes. Yes. Sheila,

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: you weren't here yesterday, but my concern is the other end of the spectrum here. I appreciate you back for saying, but when you said that your goal is 95% return of these syringes or whatever else, if that doesn't happen, what's the repercussion?

[Sheila Livingston, Interim Deputy Commissioner, Vermont Department of Health]: So we use, oh, sorry.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So I would say that's a great question, and if you can get us a quick answer perhaps by text or email, that would be helpful, because we have another person waiting to provide, senator. It's a good question.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Thank you.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Not meaning to interrupt. Don't ask it on the floor. I

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: spoke of one question. Needs to be

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: answered on the floor. I know. I've got so many answers for you. Thank you, Sheila. Appreciate your time very much. Alright. Senator Heffernan, thanks for being here.

[Senator Heffernan (first name unknown)]: Thank you, chair. And you're here to talk about? Per director, Senator Steve Murray, Madison County District. I'm here to ask to add to eight six six five seven on section 16 to add one more person to the group, to the working group. Here is the

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: This is the working group to explore.

[Senator Heffernan (first name unknown)]: To explore and to help with the pregnancies of Pregnancies, yeah. Okay. So I'll give a quick spiel. And the reason I did this, Planned Parenthood of Northern New England testified in 2023 that if pregnant women decide to carry the term, Planned Parenthood would not refer them elsewhere. And that's why I'm asked, there's gonna be other, there's nine groups throughout Vermont that would probably wanna be a part of this. I know for a fact that the Women's Crisis Center in Middlebury does wanna be part of it. Others have to go see their board, and what they do is they empower individuals to make informed choices, pregnancy confirmation with ultrasound, pregnancy wellness, childbirth education, parent education, healthy relationships, and life skill education, and maternal assistance. Offering compassion, hope, practice, help, through facing pregnancy, parenting, and relational challenges. They also offer help when the person decides to enroll. Because often or not, afterwards, there's a lot of,

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: there's a lot of Yeah.

[Senator Heffernan (first name unknown)]: I believe that it's very important we have this on the group as well to be there to offer the support. I know your concern was that they were all pro life and that they, what that sometimes represents. I can assure you that they are her life, but they are women first in their choice, and then whichever they need to offer. They love to help when they're, wanna see pregnancy all the way through, They also like to help after an abortion to help with any problems of any kind of that. So I think it's important to have these people in group as well. I only can speak for Middlebury because I did speak for them.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: That was my question. I know that you had suggested about two different Right.

[Senator Heffernan (first name unknown)]: And I know that Aspire really wanted to, but they wanna meet with their board and decide. Okay. So I'm we'll strike the thirteenth, but

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Yeah. I was gonna suggest if if we could do that, and there may be something that happens between now and the bill returns to the But I think you're having talked with the Witness Center in Middlebury, and it sounds like they have the services. They do.

[Senator Heffernan (first name unknown)]: And yeah. They do and they, no matter which way they're there

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: to

[Senator Heffernan (first name unknown)]: support the individual through a very tough time that they have to.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Okay, so what I'm gonna say right now, it's different from our process because it's so short on time, but I'm gonna suggest that if you could change, modify this proposal amendment to have just the women's center, then without objection committee, would we straw poll this one? No, This one with the women's center. Okay. No. Come back. But that doesn't matter. One of you already sitting on the table. Alright. Senator Heferny, thank you. Yeah. Thank you. I would suggest that you, change it, and then this committee will have a discussion and go over

[Senator Heffernan (first name unknown)]: it at some point. You. Thanks, Steve. Yeah. Have a

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: good day, please. You'll send that to me. Yeah. Awesome. Thanks, Steve. Okay. So we're gonna see the green light in a little bit. Happened yet, thank goodness. Senator Engel's proposal to rearrange the funding here, not something that I think, it comes out after a whole lot of work by the advisory committee, by the Department of Health, by us, and by the House. So I am for one, I can't support this, unless The committee has comments. I mean, I would love to be able to spend more time on that because as far as I'm concerned, the work that we do with this committee has always been around science, right? And addiction for us is a disease. It's not a question of being in denial or not in denial. So if it's treated as a disease, then no, I don't support ACE of Edin because of the party. We don't know what effect it has on recovery centers across the state at all. I'll talk about that. Great. Thanks, David. So, I'm so that's two not favoring straw poll. Straw poll, those for it.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Well, I as you know, I'm not a big fan of the. You could see part of it. One or two. Recovery houses from the end they lead, and the testimony we received, they're very important, and they're

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: they get people We all understand that. The point is that we would all been voting in money where there's been no testimony about how it's utilized or affected. We also know that we have another proposal of amendment, probably should have come out first, on looking at the syringe service program and how to return to reduce the problem that seems to be the biggest problem.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: That one I have no problem with.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: You don't have a problem with this one, but if you do this one, you don't have a problem with it at all. It isn't there. Screw. Yeah. So I mean, I think Sheila made a good point about trying to minimize the spread of disease. One of the reasons why we have the needle exchange. Right. It's really important. So on this one, on the Norris proposal, could I see a straw poll for this one? Can you remind me exactly what it does? It has a plan. Department of Health will have a plan to make sure that needles are returned Okay. With a 95%.

[Sen. Russ Ingalls]: It sounds like they're already doing Sure.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: They're they're doing it because we talked about it. And and it's because we did have a program with the Howard Center, and now they're doing it again.

[Sen. Russ Ingalls]: Just so you would

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: So I am I am really loath to put this one forward. Loath? Loath. Loath. That's a

[Sen. Russ Ingalls]: good one. That

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: word word here. Road to recovery is not a straight line. It's true. It's up and down. So I do not support that one. I'll ask senator You can explain. And use for it? No. And I see he's on the fence. Okay.

[Sen. Martine Larocque Gulick, Vice Chair, Senate Health and Welfare Committee]: Well, I split on it, but Okay. This stage. Yeah.

[Sen. Virginia “Ginny” Lyons, Chair, Senate Health and Welfare Committee]: Alright. Good. So we'll but then on the we have to go upstairs. Yeah. The women's center, let's hold that thought, but I'm not I think fun for it. I think it's fine. Yeah. I don't, but that's okay. Okay. Okay. Strawful. Okay. Alright. Also, who's doing Sandy Hoffman on the floor? You are. I do. I'm gonna Yes. Once you once you have it, you've got it. And if you're gonna be I'll be off.