Okay, so we are live now and we are joined today by a few members of the House Health Care Committee and also by Nolan Langwile of Joint Fiscal who has worked on many of these issues around EMS funding. So, thank you, Nolan. You can feel free to turn your video off if you feel like it, but we may call on you. So this is the House Government Operations Committee. We are going to do some work today that goes along hand in hand with S182 that we passed out of committee last week and this is to dig into some of the background around funding of training for EMS providers and we had had a flurry of emails in conjunction with S182 when it came over, just explaining how tenuous the financial situation is for EMS services during the COVID-19 pandemic and so I thought it would be helpful for us to understand the context of what the Health Care Committee has done and then I can fill you in a little bit on how the Senate Government Operations Committee has proceeded and we can have a bit more of a committee discussion about how to move forward. So before we get started Andrea, I'm going to ask you if you can try to email Rob and see if he's having trouble getting in. His identity still says he's joining, so I'm not sure whether he's got a challenge or maybe he's just stepped away from his computer before pushing go. All right, so welcome everyone. Thank you so much for being with us today. I think that what would be helpful just for context setting would be to have Mari and or David from Health Care, House Health Care, describe to us what was contained in the bill that you passed out of committee and then a little bit more on where that bill currently is. So I don't know if you two have already talked about who has the- Mari, you reported the bill, is that correct? That's correct. This is representative from Lincoln and House Health Care Committee. We worked on, House Health Care worked on H742, which was the original sponsor of the bill was representative Harrison and the problem that H742 in all of its forms until the major amendment, which I'll get to was to address the critical workforce shortage in Vermont's EMS system, particularly at the local volunteer level. And now when we need them most, there is a trending decrease in the number of EMS providers in Vermont. And just for an example, in 2019, EMS responders in Vermont answered more than 97,000 calls. This is pre-COVID and 79% of those services reported not having adequate staff. And from the testimony that we heard, the main obstacles to maintaining or growing the workforce were cost of training and the actual process to obtain funding to do the training was burdensome. There was a lack of consistent leadership personnel in the existing state training coordinator. And then the appropriation of funding to these EMS providers has not always been needs-based, which has led to inequity in where the funds have been distributed around the state. So just as a review, I think you've probably already heard this and Department of Health and Mr. Hazelton from MSAC will likely get into this in more detail. But the current funding for training for EMS providers comes from assessments on various forms of insurance that comprises revenue to the fire safety fund of the Department of Health. And from that fund already established is $150,000 per year that is designated for the emergency medical services fund to support training and other activities related to the delivery of emergency medical services. When we passed H742 out-of-house healthcare at that time, the fund, the EMS fund had $375,000 in already appropriated undistributed training funds. So the original form of H742 from Representative Harrison was much more comprehensive, involved more money and more appropriations. And I'm not recalling the specific history of how we ended up with the bill that we passed out of committee, but it's much shorter, it was much simpler. And the amount of money that we were was already appropriated, so I'm not sure the word, but asking that it be used because it was already there, we were directing the Department of Health to actually disperse the money was $300,000. And then prospectively for the next fiscal year, there would be another $150,000 deposited into that account as it had been in previous years. So that's what the main part of the amended by our committee H742 did was direct that $450,000 be distributed through Department of Health in consultation with. And this is something else that we added after we heard testimony from EMSAC, the Emergency Medical Services Advisory Council, which was established in statute. We heard that there was a need for EMSAC to be more routinely and directly involved in how training funds were distributed. And in other activities related to emergency medical services. So our H742 added language to make sure that EMSAC would be directly involved and recognized by the state as the entity that would help with this process. We heard from the sponsor, Representative Harrison, and then the chair of EMSAC, the Emergency Medical Services Advisory Committee, Drew Hazelton, from the Executive Director of the ANA, the lobbyists for the American Property Casualty Insurance Association, from Senior Fiscal Analyst from JFO, Public Health Policy Advisor from Department of Health, EMS Chief from Department of Health, and Deputy Chief Council, Ledge Council. Now, Representative Durfee and Harrison, I don't know if you want to add anything more. David, go ahead and unmute yourself. Thank you. And maybe get on the screen, actually. This is Representative Durfee. I don't have much to add to Mari's testimony. And I think she covered it all. Jim might have a different perspective since he was part of the original bill. And I think also having Drew Hazelton here and Shayla living instead will be very helpful. Great. I would just like to add that since we all left to have these meetings at home, I have reached out to the Secretary of Agency of Human Services and the Assistant Secretary to ask about where we were at with funding EMS services. And I've also, and I haven't heard a little bit, but I haven't gotten a complete answer to my questions. I've also been hearing from EMS providers that our constituents is early on in the COVID situation. But they were saying was not good. They were not getting the help that they needed. And I won't go into those details because we have other folks that can testify to that. Oh, and lastly, this bill H742, Pat, we passed in the House on March 13th, Friday the 13th. And as soon as it was passed, we went through all remaining stages of passage, turned it into an amendment. Our committee amended it and it turned H742. It was a strike all amendment. So none of the language that I just talked about actually moved forward because we used H742 as a vehicle for the COVID response, mostly around healthcare and DFR and licensing. And at the time, I assume your committee wasn't considering the original language to be strictly COVID response. And so that's why it didn't make it into the March 13th final bill. Yeah, we felt that the COVID responses that we had been working on that with stakeholders and lobbyists and other legislators was of critical importance. And we just wanted to get the COVID bill out and across to the Senate. Okay, great. Thank you. Jim Harrison. Yeah, thank you. Thanks, Marie, for that summary. I think you got it pretty much everything that happened. A number of you in the committee also signed on as co-sponsored. I think there was a lot of interest in the whole issue of providing some help with training, especially when it came to our volunteer first responders, who in many cases are expected to come up with six, seven, eight hundred dollars for the privilege of volunteering in their communities and wanting to help. So I do have to tell you, as I think back to whatever date it was, March 13th, and I sat there in the House floor and 742 kept getting passed over and over and over. I didn't know exactly what was going on. I didn't think the bill was controversial, but then I noticed that the healthcare committee sort of was disappeared from the House floor. The House actually kept the original provision as passed by committee in the bill. The Senate ended up taking it out just to make it, I think, clean and COVID related and timely, but be that as it may. I think there was some pushback on the original bill because it provided a little bit more money for training, 750,000, and that money came from a surcharge or an increase in the surcharge that's currently assessed against insurance companies for auto homeowners, property casualty, and I suspect some of the insurance carriers or their representatives didn't want to see any kind of increase. So I think that pushed it back and to come to appropriations with new money is always a challenge. So I commend the committee for what they did. It's just unfortunate circumstances. We weren't able to get that piece done. Thank you. Thanks for that context, Jim. I appreciate it. So I think next what would be helpful is if we heard from Drew Hazelton who can help us understand a little bit more about the challenges that EMS services have from around the state. So, Drew, go ahead and unmute yourself. Thank you and thank you for inviting me. I know some of the people that are on the call, but just a quick introduction. Drew Hazelton, I'm Chief of Operations at Rescuing down in Browderboro. The Vice President and Legislative Chair of the Vermont Angels Association and I do chair the EMS Advisory Committee. I've been working in EMS in Vermont as a volunteer and career for about 25 years. So I did send a couple slides ahead. I don't know if we can put those up or if I should put those up. I don't know how that works during these type of meetings. So they are on the committee's page. Andrea tells me. And so I guess committee, I'm wondering if you would prefer to have a screen share on screen right now in which case one of us can fire it up or conversely, if you have a second. Okay. So Andrea's got the document up. Andrea, let's go ahead and have you do a screen share while Drew is talking and Drew, if you need her to scroll through it at all or if it's multiple pages, you can let Andrea know she's listening, but her computer audio is not working right now. So she should be able to respond to you, but she may not verbally respond. Great. So I tried to put together a simple kind of state of the EMS system in Vermont using a lot of the information that we've already presented through the EMS advisory committee over the last few months. So as we heard a little while ago, EMS in Vermont runs almost 100,000 calls a year. And that's done with about 2,800 EMS providers working through 82 ambulance services and 92 first response squads. So I think it's really important to recognize that EMS in Vermont is very different than EMS in a lot of the rest of the country. Most ambulance services in Vermont are not municipal. The majority of these services are actually nonprofit either serving one or multiple communities. And again, 93% of transporting agencies and 97% of our first response squads are actually volunteers. I really think that's important because we're asking a lot of these volunteers and a lot of their time already in the sense that we expect them to go out late at night and go out and keep up with their training and education. And currently we're also asking them to go ahead and fund their own EMS education. Slides go down. Yeah, hang on just a second because Andrea is having a little technical difficulty. Her internet is acting up. Let me see if I can have that. All right, here we go. We just scroll down to the next page. Andrea, how's your internet working now? Are you able to scroll through the document? My apologies. We'll hopefully we'll get this back on track in a moment. There we go. Now you're scrolling. Can you scroll to the second page, Andrea? So Andrea, we can see only the header of page two. So if you're able to scroll a little further, great. If not, we can kick it over to Betsy Ann who's able to share screen. All right, let's go ahead and switch over to Betsy Ann's share screen because we are having some internet challenges from Andrea's. Adam Chair, is this on our committee website? It is on the committee page. And so if folks are watching on YouTube, they can go to the House Government Operations Committee page. Oh, Betsy Ann, you'd like to be a co-host so you can share screen. Hang on. See if I can find Betsy Ann and make her a co-host. Why am I not allowed to make Betsy Ann a co-host? You got it? Okay. Here we go. All right, my apologies, Drew. Page two of your document will be coming up in just a moment. Should be back one. Okay. I put this up, the slide, and the reason why I wanted to kind of explain this is as we start looking at COVID, the disaster that we're facing right now and the impact on EMS services, I think it's important to understand that again, the majority of services in Vermont are not municipal. These are some slides that were created for the legislature a couple of years ago. And as you can see in the picture to the left with the kind of full-time municipal department, the majority of that funding for those services is actually coming out of municipal dollars versus what is the example in the lower right-hand corner, which is Essex, which is a private nonprofit serving multiple communities. The vast majority of their funding is actually coming through Medicaid Medicare dollars. So there's a disproportionate effect on the actual revenue streams of these services. And in a lot of cases, these services do not have the financial backing of the depth that a municipality does. Once their bank accounts are empty, then they're in trouble. So we've had a lot of different effects. And as our annual associations reached out to our membership as we've talked to services, we've heard everything from loss of workforce, lost fundraising opportunities due to events that have been canceled. We have some annual services that are completely funded based on fundraising in Vermont. We've heard about lost revenue due to community education because we're no longer allowed to kind of hold these in-person CPR and first aid classes that generates a lot of revenue and a huge loss in billable revenue. And I'll explain that a little bit more in a minute. We've also seen increase in costs. And I think it's important that people understand that ambulance services were required to early on purchase the PPE that we needed. And we're still encouraged to purchase as much PPE through our standard vendors as we can, though some equipment is not available. And services have spent a significant amount of money. So as an example, our service in Brattleboro has spent more in the last five weeks on disposable supplies than we have the previous 12 months paying for PPE and equipment, as well as disinfection. Something that we don't think about much is the amount of additional time it takes to deal with infectious disease patients. And now that we're treating most every patient as if it's an infectious disease patient, the amount of additional work hours, not only on the on the cruise, but on the disinfection and the amount of time it takes to to go from one call to the next is significantly increased, causing a lot of overtime. So if we could scroll to the next page. And there's a lot of numbers on here. So, but I thought it would, I would try to explain to you what we deal with every day. So maybe you can understand what we're dealing with today. So this is a rough example. And this is based based on our operation in Brattleboro. So over the course of two months, we run about 1000 calls. So this is is oversimplified, but hopefully it gets you to thinking about how angels companies stay in business. So the basic formula for this is the number of calls we go a times the billing rate equals the revenue, and that fills in the vast majority of our operating costs. And on a normal scenario, though again, this is oversimplified, we have about 18% of our calls where we go out and we don't transport patients at all. And because we don't transport, we can't get paid for those calls. So our total loss in revenue is the difference between that 500,000 and the 410. And that's $90,000. This is on a normal day that we lose to non-transported patients. In our area right now, 18% of patients that do get transported, we also just do not receive any funding for. So out of what should be a $500,000 revenue on a normal, you know, six, eight week period, we would collect about $336,000, providing about $163,000 worth of free or charitable care. That money is what is made up by the municipal subsidies fundraising and grant dollars in annual services in every single community in Vermont. If you look down to the yellow section, what COVID has done to this is we've got a drastic decrease in our call volume. I ran these numbers so that they're accurate in our system and I've spoken to services all of the state and I know these numbers represent what everybody else is seeing. We had a 42% reduction in calls. We also saw an increase in the number of people that do not want to be transported to the hospital from 18 to 23%. People are afraid to go to the hospital. So again, ambulance services get paid based on transporting and moving people. So you'll see the net reduction from the 410 down to the 224,000. I'm still calculating at 18%. I'm sorry. But the estimate is that we're going to see a much higher bad debt number than we have before because of the number of people that are currently out of work unemployed and have large deductibles on their insurance. So in the last six weeks, we've seen $152,000 loss in revenue. That's not money that we're going to see anywhere. That's money we have to make up in our operating budget somehow in the future or expenses that have to be cut. So to put this into perspective for people that are rescue service, 15 towns, about 500 square miles, about 32,000 people. And usually at the end of our fiscal year, we're somewhere in the two to $10,000, either plus or minus, our operating budget. And in the last six weeks, we've fallen $152,000 behind. So when we said this is a crisis, this is a crisis for EMS across the state. So there have been some direct funds that have come through the Agency of Human Services as far as offsets to help with Medicare money that has been lost. So we were fortunate to get about 80,000 from HHS as part of the CARES package to kind of fill in a little bit of that $152,000 hole. We also have applied for many of the other programs that small businesses have in Vermont in order to help us keep the doors open and the ambulances out and running. But it is a real issue. And the longer the pandemic goes on, the longer the call volume stays, the more difficult it is going to be to fill in the voids. If you want to go to the next slide, I'll tell you about the education component. And this is information that was put out as part of our EMS advisory report. I think you guys have that already, so you got it earlier. Workforce development has been our number one priority for our EMS advisory community for the last couple of years. And it's because of the numbers in the chart. We're losing and turning over 20% of our workforce every year. First of all, we need to figure out how to retain people because losing 20% of our workforce is not sustainable. And the second component of that is we're seeing usually year over year between five and 10% increases in our call volume. And we've seen a steady decline in the number of responders we have in Vermont. You'll see the quotes from the advisory report. 80% of services pre-COVID were reporting workforce shortages, poor access to education, increased costs. What we expect now is even worse. What services did have available for funds to help support education, as you saw in the previous slide, doesn't exist. What individuals had for willingness and available funds to pay for their own education we can only imagine will not exist post-COVID. The EMS office has put out a survey to the districts looking for input on the status. And I put some quotes there from last week's report. And if I had a bigger slide, I could have put more. But the point is we are seeing losses in EMS providers directly related to COVID. So I believe and most other administrators believe that that 400-person loss in EMS is going to be significantly greater this year as a direct result of the COVID crisis. And that's why I think it's very important that we get funding for EMS. Is there questions? All right. Committee, do you have any questions? Rob LeClaire, go ahead. Thank you, Madam. Hold on. Can you hear me? I can hear you. Okay, great. Thank you. Sorry, I got to catch up with my screen. Do I got a couple of questions? One, you have kind of a cumulative number that we're looking at statewide? If you're saying that you're 152,000, just your service, we must be a million plus dollars in need for one. And two, if you've had a declining and run volume, does that 152,000 that you show that you've lost, does that include decreased expenses as far as or have you seen a decrease in expenses as far as not having to pay overtime or backfilling shifts and stuff? So unfortunately, the decrease in run volume has not decreased the overall cost of operating because the cost of readiness is there. So we have to have the staff on in order to meet the need of the calls when they do come. So if people would schedule their emergencies better, we could probably lean down the staff, but they don't seem to work that way. What we have seen is an increase in our overall costs. So at this point, we have over 30,000 in additional expenditures related directly to purchasing of PPE and equipment related to COVID. So we have applied for the PPP program. One of the challenges with that PPP program is that you have to maintain staffing. So we will be maintaining the staffing for at least the next couple of months as part of the program. And I know like that us and other services are going to have to seriously look at our ability to maintain workforce if the call volume doesn't increase and if the revenue doesn't come back. And what that means for the towns that we serve are longer response times and possibly no ambulances available to respond to their calls because we don't have the crews on. Rob, does that complete your questions? There we go. Thank you. Mike Marwicky has a question. Thank you, Madam Chair. Rob, pretty much touched on what I was asking about how I appreciate that we're getting the view from Wyndham County, but the big picture, I think, is what we need to know as well as what we're going to need or what they're going to need for resources looking statewide. The other piece I wanted to ask Drew is how timely are these needs or what's the timeline? I think the last time you talked to us at the Wyndham County delegation, you talked about how your cash flow is getting pretty darn tight. So can you give us an update for you and what others around the state are experiencing? So yeah, so when I spoke to the Wyndham County delegation that was ahead of our HHS payment, which certainly helped, and the loan that we got under the Paycheck Protection Act. So currently our cash flow is stabilized for the next eight weeks under the federal program. And between now and the end of that eight weeks, we'll have to figure out how we're either going to maintain or change the staffing levels. I did speak to at least a half a dozen other services in the last couple of weeks that have also received the HHS money. And I was actually speaking to a smaller service this morning that was successful at getting their PPP money. So my understanding right now is that most ambulance services have been successful at getting the kind of the temporary federal funding to keep them operating in the short term. On the education side, one of our fears in the EMS advisory committee is discuss this and continues to discuss it as one of our priorities is the longer that we wait to start restart our education system, the longer we're going to be before we can get the workforce out and fill in some of the holes and the gaps that we have. So the sooner we can get the funding and infrastructure in place and the advisory committee is ready and willing to stand up whatever we need to in order to get EMS education in Vermont, the better we're going to be. It takes between three and six months to get a new person through an education program. So if we wait for the end of the COVID response, it's going to be way too late for us to keep these services responding. Thanks, Drew. Mike, does that satisfy your questions?  So I've got Jim with a hand raised and then Hal. Go ahead, Jim Harrison. Yeah, thanks Madam Chair. Drew, if it sounds like most of the services might have qualified for the PPP or whatever the acronym is, is that fair to say? So the ones I've spoken to have applied. A lot of them have the money, but there are smaller services that we have not been able to get in touch with at this point. So I can't tell you that it's 100%, but I do know that out of all the aid bill services I've spoken to, they have been eligible and have received the funds. And plus some may have gotten some extra help with the Medicaid shortcomings. Is that also what you're saying? So the Medicare put out. I'm sorry, Medicare. I thought it was Medicaid. Okay. And that was an automatic payment. So services did not have to apply for that program. So our assumption is that every provider that builds Medicare in Vermont did receive that as a payment to their interchecking accounts, the same as they would their normal Medicare money. I know a couple of services that have applied for Medicaid money. I don't know of any that have received any. Okay. Thank you. So I'm just trying to ascertain right now. And I was, you know, the outsider that crashed your Wyndham meeting there a few weeks ago. And thank you for the education you provided, at least for me. But I'm trying to get at is, you know, we've got really limited resources right now statewide. And we don't, I guess, know exactly what COVID funds can be used for and what they can't be. Is the primary concern today, the lack of training resources to help with the next number of people that we need to fill ranks? Or is it the cash flow issue where the alarm bells were going off a few weeks? And for your service, it sounds like some of that's been at least temporarily resolved through the federal COVID program. So, yes. So you're the emergency as far as the cash flow for our service and some of the other services I know has been mitigated with the short term solution. But we do need to find a more long term solution, whether that's adjusting our Medicaid rates, whether that's funding directly for ambulance services. We do need to find a long term solution because the federal PPP money unless it is renewed will run out long before the COVID response does. The funding for education is going to be critical in order for us to come out of this COVID response with a functioning EMS system. So if we can't get that funding approved and that system up and running, we're not going to be able to recover from this. Okay. Thank you. How did you have a question? Yes. Thank you, Madam Chair. And thank you, Drew, for this overview. Do you have any sense how the EMS providers are faring in New Hampshire and or Maine? Are they having similar challenges? And if so, how are they approaching it? So I know that they're having similar challenges. We are a border service, so I receive a lot of the New Hampshire communication. I can't speak to Maine. So in New Hampshire, they're struggling with the same numbers of reduced call volume and reduced revenue. I know Massachusetts has increased their Medicaid rates by 50% to help address some of the funding shortfall to ambulance services. So they're having the same problem as Massachusetts and their approach has been to increase Medicaid to help offset some of those losses. And I just got a note. Maine has also increased Medicaid rates to 100% of Medicare in order to meet the need of services. Thank you. John Gannon. Thank you. Drew, you ever really mentioned the emergency medical services special fund and how that could help with education? So the special fund was created and distributes about $9,000 a year to each of the EMS districts. And it has been doing that for quite some time for EMS education. What we were working to do this year was to address the difficulty of access in the shortfall in education dollars, which is what House 742 addressed. And that was as a result of the study committee, the emergency medical services committee's work looking at and researching what was causing the decline in our workforce. So the money that was in the fund or the money that currently is in the fund is money that was intended for EMS districts that was never distributed to them, generally because the amount of administrative work in order to get the funding was difficult. Many of our EMS services are small volunteer, completely volunteer operations. They don't have administrative overhead or administrative staff to fill out the applications and the grant funding. So a lot of the money that was available is money that was supposed to have gone to districts, but they weren't unable to get it because of the kind of the paperwork shuffle in order to get those funds. So we were looking to get funding directly for EMS education, specifically classes and online education for EMS as part of H742. Last week our EMS advisory committee met looking to get some sort of distributive education up and running as soon as we can so that we can start filling in what we know are huge holes in our workforce. So the committee agreed to have to the kind of the concept that the EMS office was going to get some proposals together on ways to get online EMS education out to our services as soon as possible. So at this point I think the EMS office is very close to a kind of like an online structure and hopefully we'll be moving forward with education soon. This is not something new in Vermont. We've been running online education in some areas. UBM currently has multiple EMP classes that are running as hybrid models. So it's been done. It just needs to be expanded so that we can have access to kind of all corners of Vermont and hopefully kind of fill in some of those gaps as we're working the way through the rest of this pandemic response. Any other questions John? So let me ask yeah I just have one other question. So I'm reading the the statute 18 VSA section 908 and in subsection B it says the commissioner of health shall develop and implement by September 1st 2012 online training opportunities and offer regional classes to enable individuals to comply with their requirements blah blah blah. Was that done? So the EMS office maintains a program it's called center learn where there are some continuing education components. It's also where education is some of the protocol education is rolled out. That platform has never been used for initial certification or for re-certification which are the two biggest components associated with EMS education and just I think it's important to note that the state training coordinator position at the EMS office has been vacant with the exception of 12 months for almost six years which is one of the identified challenges that our EMS advisory committee looked at as one of the reasons why we're struggling so much to get appropriate education to EMS. Thank you very much. Thank you committee any other questions for Drew? All right I will just oh Rob LeClaire go ahead hand up. Thank you Madam Chair. Drew I don't know if I heard do you have an estimate as to what we're looking at statewide as far as the shortfall? So we did a very informal survey to the EMS to the ambulance services across the state and actually can I answer that in just a minute so I can get the exact number for you? I'll pull it up. More action is better. Good question. We'll give you a few minutes to dig around for that Drew. In the meantime we have Dan Batesy who is the Emergency Medical Services Chief at the Department of Health and so Dan if you would join us and help us understand what what's going on from your perspective. Thank you Madam Chair and thank you to the committee for having time for me this afternoon and Drew thanks very much for a concise picture. I think he's done a very good job of describing a lot of the crisis that we're facing these days. It's true there's a lot of challenges in front of EMS education being a big one and I'd like to reiterate the picture that Drew put we do lose about 24 percent of our population every year to folks who move on to other jobs and to retire and to replace them we've got to bring in somewhere in the order of about 500 providers and that's we've been pretty good at it we've been good for the last five years we've had roughly a net zero in terms of loss of folks but that means we've got to have a sustained education program and keep it going and COVID-19 has created a pretty significant challenge to that. Now this is not a new program a new problem rather we've been talking about this and Drew alluded to this fact but even before COVID we were working with the advisory committee to work on some of these long-term education programs and I wholeheartedly agree that it is some degree of insanity to continue asking people to pay to train to then go on and volunteer. I think that's a flawed model as we as we look ahead to sustaining a volunteer system. So prior to the COVID-19 response we were working with the advisory committee to do just that. We had the notion of centralizing some measure of education in Vermont. We had some idea of underwriting at least a portion of the cost of training for folks who were going to dedicate themselves to the volunteer ambulances and to the volunteer services out there and we were working with that. We've been talking for a long time about an online education model where multiple districts with varying infrastructures could have used these these centralized resources to bring education to the places that otherwise they don't get there and that's certainly been the challenge right. Drew alluded to the fact that using that special fund has been difficult and it's not just the paperwork that's been the difficulty although certainly the administrative aspects of it have been a limitation to distributing those funds but it's also being handed to districts that have very limited infrastructure in some cases. We have districts that have a lot of infrastructure. Drew's district has with the good graces of his agency have a lot of capability to provide education and to train but in other districts districts that have one or two services they have very limited capability to put on EMT classes and very limited folks to teach and to to provide the resources that are necessary for an EMT class and yes $9,000 is nice but if you look at the cost of an EMT class it costs somewhere in the order of almost $650 a student to simply put the class on so if you're talking about a class full of 20 students that $9,000 doesn't even cover that cost so then the the cost goes to the students who have limited capacity to pay and so on goes the cycle and that's the challenge that we faced. I think a lot of the fact that the special fund has been underutilized is less to do with administrative paperwork as it is to the fact that districts just kind of look at it and say we can't do this where we don't have a good outcome at the end of this so why are we continuing to push all these resources towards it when it's a limited capability and that of course is the challenge of trying to get the education to exactly the places where we need it the most the remote low population areas that need providers on a regular basis that need them in many cases more than the high population areas do so we've been working on that in fact we've changed the process of going out and putting the money out the application process if you will we changed it four times in the four years that I've been here we've created templates and models to make it happen but the challenges are still existing and and I think that this is an ongoing issue. Before COVID we had talked about the idea that maybe this is just not the right way to do it that maybe there was a better mousetrap to be had and that means creating this centralized infrastructure to take the take the the role of some of these districts that just don't have the capabilities to do it themselves and then COVID-19 hit and that changed everything for us you know our entire operation at the Department of Health shifted to response every single person that had a moment of thought to think about EMS was now shifted into the health operation center and you know that included not just EMS but managing the hospitals and the long-term care facilities and the outbreaks and all of that happened and for the last two months we've been pretty darn busy trying to make sure that all of those things happened but nonetheless we've tried to keep up we've tried to do the things that we needed to do to to meet those of course the biggest issues in the response have been other things besides education you know we've had to create a PPE distribution system that's given out 18 000 pieces of personal protective equipment per day for the last two months we basically invented amazon.com from nothing to a full functioning corporation in just a little more than a month and a half so that's been a huge challenge and then we've had the social distancing issues where the infrastructure that we normally would stand up for an EMT class that is having people in a classroom and being evaluated with hands-on skills we just couldn't do that anymore it just wasn't uh wasn't appropriate in the context of the pandemic to do that and that's been a pretty big challenge now we've worked hard to try to fix a lot of those things we've certainly stood up a fair bit of resources on our end we brought another person into the office to to work as the acting training administrator to help us with some of these issues we have made a lot of changes we've increased the well we've pushed back I should say the licensure renewal date for folks who are recertifying their license this year that's gone back for a three month period we've changed the requirements for an ambulance crew we've uh used to be a two a two licensed provider rule we waived that rule in the context of the of the pandemic to just one to enable agencies to use drivers and to use volunteers uh that aren't fully trained to sustain their operations and I think that's been successful we've changed how testing uh requirements are our uh we've changed the requirements of testing uh around licensure systems so that students who have already been partially through a class had some capability to come back and uh complete their uh to obtain a provisional license so that they can again feed into the operation as well um and then of course we've had to address the day-to-day stuff that's going on and that's been a matter of trying to keep people informed and we've done that with a variety different mechanisms and means we've uh had a a weekly phone call for first response agencies we've done a weekly email we've done a daily situation report from the seoc trying to make sure that all of the opportunities for funding like the Medicaid retainer and the FEMA grants and a number of other opportunities are tried to be pushed out there as timely as we as we possibly could um and then of course we had to address the education piece and Drew's absolutely right uh if we if we don't act on education we're going to be not just three months in the hole but um we are going to be in a hole of people because we've got to sustain that roughly four to five hundred people every year to keep our ranks at a net zero so what we've had in mind and we've been working with the uh advisory committee on this as well is to try to do a COVID-19 EMT program that combines distributive mechanisms um uh that would mean that a portion of the program would be done online and then to to backlog uh to push to the end of the class the hands-on and the psychomotor capabilities that are or required I mean we can't take an EMT class without learning some hands-on skills it's just really not possible but what we figure is that we can put people into this program and then work with local infrastructure later to complete that training so that when the restrictions are lifted and we're very hopeful that they'll be lifted in a relatively soon fashion um that when they're lifted we can then get these folks into the system faster so that is they're not waiting for three months to start a program and to begin anew um so that's what we've had in mind with the advisory committee and that is where we worked with them to try to utilize some of those uh unspent special funds to pay for this we've also had the notion that this class in the time of the COVID response should be underwritten and should be a very low cost and in fact at this particular moment we're talking about making it about a hundred dollars to take this class we uh we'd like to make it free but our concern of course is that when we make it entirely free no one has skin in the game and that means a little bit of difficulty keeping students properly aligned to classes and things like that so we have in mind that we're going to charge about a hundred dollars and then use the rest of the money to offset the costs our plan is to use an existing vendor that's out there we've been working with the state of Maine we've also worked with the state of Massachusetts and New York to look and see what they're doing Maine is probably doing the closest thing to what we have in mind with an online hybrid EMT class and we're trying to model what we're looking for there it's our intent to put out as Drew mentioned not really a request for a proposal but a review statement to four possibly five programs and two including two here in Vermont that we believe have the capability to to do the things that we need to do that is the the online infrastructure and the online previous experience working with that platform to be able to to do these things our review process is finished we're hoping to get some of these programs under review by the end of this week and if not fully into next week we'll be looking at that our goal is to select a program by the 20th of May and then begin enrolling students for the end of June and that would serve then as our hybrid program and allow at least some EMT education to occur during the COVID-19 response. Our hope also is that this can serve as a type of review a pilot project if you will to see about long-term feasibility because it would make sense to me at least and I'm not only the EMS chief but I'm a longtime EMS educator I spent nearly 20 years as a paramedic program director before I came to Vermont it would seem to me that this makes sense from a from a centralized standpoint that this is a model that we need this is the model that might work as we recruit students into our system now I want to be clear that we don't want to step on all of the infrastructure in Vermont and shift it to this because there's a need for other types of education UVM for example trains a good many students that will never see the back of a Vermont EMS ambulance they're the ones that are you know going to their home states and working there but they still also train a whole lot of Vermont EMS providers too so we want to make sure that we sustain them and I think that if we can prove the feasibility of this I think if we can prove that it works and that it's a manageable system this might be the answer to having some measure of full-time annual programming that volunteer agencies can turn to there where that special fund money can be spent very effectively and with good utility so we're hoping that will start immediately now the challenge as we go on is of course sustaining it right we'll have money in the special fund right now that unspent balance to pay for this but we're looking at probably somewhere in the order of about a thousand dollars an EMT student to run this on a on a regular basis now again I don't have an exact number because we haven't had any proposals yet we don't have anything to review yet but that's based on estimates from Maine and Massachusetts that's how much students are paying right now so we're estimating it's going to be somewhere in that order and we're going to have to look at that in in terms of what our annual goals are again I don't think that we're going to train all 400 EMS students every single year using this model but if we could train 150 if we could train a couple hundred that would certainly go a long way to to sustaining the ranks of the volunteer population especially if we made it preferential to those volunteer candidates based on recommendations and service chief approval things like that so there that's the next piece that we'll have to begin to look at and we'll continue to work with the advisory committee on on what their vision is and how to best roll this out and then finally I think the challenge that we're going to also be faced with is how do we look to the future and how do we find a reimbursement model for EMS that doesn't get them into a challenge every time we have a situation like this every time call volume drops and by the way you know that although we're certainly highlighting COVID as a problem here with this reimbursement model the reimbursement model was flawed way before COVID ever came around and the notion that being paid only for transporting people doesn't pay you to train it doesn't pay you to be prepared and it certainly does a disservice to those folks who transport very few people all the time the fact of the matter is if you live in Brighton and get hit by a car you want to have the same EMS standard as you do in Burlington but we know that folks in Brighton are transporting a heck of a lot less people than the folks in Burlington are so we've got to figure that out and I think there's some some interesting models out there that I think there's some interesting ways to think about it but that's going to have to be a project as we look forward so I think that's pretty much where I'm coming from I'm certainly happy to entertain your questions thank you Dan I appreciate that committee do you have questions right I am not oh Rob Leclerc has a question go ahead Rob thank you madam chair Dan you know one of the the you made the comment that you know if somebody needs an EMS service in Allen Paw that you want the same as in say Burlington and that in itself seems to have been some of the challenges that people have in that as much as we would like that to be the case I would rather just have somebody qualified to show up rather than nobody at all um are we making it more difficult and less attractive for people to become part of the EMS service by having these I guess criteria out there that in some cases I I think are acting as a deterrent for folks yeah thank you representative and that's a very good point you're correct island pond doesn't have a 300 000 volume library either and the taxpayers and in that municipality have decided that's what they're happy with and I think it's very reasonable that people make educated decisions about the level of EMS that they choose and there are different levels maybe you don't need a Cadillac maybe a Chevy will do and I think I think that's a very reasonable conversation to have as long as people are educated about it as long as they understand what they're what they're getting I think one of the big challenges we have in EMS is it's like sausage and laws is that nobody really wants to understand how it's made and fully in Vermont very few people really understand what they have already when most people imagine EMS agencies they think of a fire department with a pole and people sliding down and being in the station 24 hours a day they don't imagine the volunteers with the pager on their belt getting up from Thanksgiving dinner and rushing to the ambulance station to get the ambulance out so I think we have some education to do and and Drew has presented you some slides that we created just for that purpose for the purpose of educating the stakeholders on on what that means now to come back to your original question however I think you're right and I think there is such a thing as as creating standards that are too high I think there's a situation where if we make the entry level too sophisticated then we loop we stop it from being an entry level and people in on the EMS side will hear me argue this about at meetings all the time when we're doing a protocol update right now as a matter of fact and all of the EMS folks would like to have every you know fancy gadget and new medication and new thing at their level but I say all the time that if we keep adding and adding and adding an entry level class is an entry anymore I think we've done a pretty decent job of balancing minimum standard from the best and the brightest in fact in the last five years the standards the annual recertifications enters have actually gone down they did when we changed over to the national continued competency model with the national registry five years ago it actually reduced the number of hours that were acquired every year but I do appreciate what you're saying and I do think it's important that we don't lose sight of that and that if we make this initial training class a thousand hours long no one will take it to volunteer and I think we have to be cognizant of that thank you committee any other questions so Mari or David is there anything that I think we should know that hasn't been brought to light here based on your history with this this subject Mari go ahead and unmute yourself it sounds like what I've been hearing from my constituents including from Bristol Rescue including about the PPE and the training and I just want to put a plug in to I have been reading the Senate bill that's in your committee now and if you do move forward with that in some form house health care had put reporting requirements in our bill and we would appreciate that if you have any reporting requirements that house health care be included oh excellent idea thank you didn't think about that uh okay committee any other questions for any of the folks who've testified so far go ahead how uh thank you madam chair um the question for Mari in your testimony you mentioned um some concerns around equity with regards to training and just wondering if you can say more about that like what's being done to address it thank you um I drew the testimony um from Drew Hazelton we learned that the the just the process by which funds for training were were allocated was inequitable and I think part of that was the um the application process being onerous especially for the the very small services that only have one or two people um in applying for the the funding was a challenge and that might be something that Drew could could speak to as well do you have any thoughts Drew so that is um accurate as far as getting the the available training dollars the other difficulty that uh we have heard is dig a especially a smaller area where education is not being offered so um our area for example um we have a concentration in our Brattleboro areas so classes are quite often held in Brattleboro but we have services that are are very small where people are are coming home from work and then having to spend an hour driving to um their class location in an hour home so you take a three hour class on a typical evening uh turns into a five hour commitment two days a week and every Saturday and with the original um bill one of the the goals was to make it more equitable equitable by having that online education component so that now at least if they're committing to that three hour class uh they're only committing three hours and not that additional two hours of travel so there is equity in the distribution of funds as well as the availability of classes and then the third area was access to testing which requires new EMTs to travel to a handful of sites either in the state or out of the state for their written exam and then many of them having to travel from one corner of the state to another for their practical exam and those were kind of the inequities that we were working on um and addressing as part of the original house bill and the original senate bill that we were working on I do have the information on the other question when you're ready yes go ahead so the question on total losses so we did a survey of services and this information is a couple weeks old now but out of a total of 22 services serving 238,000 Vermonters their projected losses were 630,000 and that was for this current six week period that we're in or roughly two dollars and 75 cents for three dollars per capita um is what the estimated loss to an bill of services currently is excellent thank you for looking that up um Mari did you want to add something to that yes to the previous conversation uh correct me if I'm wrong Drew but I think also one of the the issues that you mentioned was the existing position of the straight state training coordinator not having been filled for um fully for most of the last four to six years and that having um a state training coordinator position filled would help with the standardization of education and would help with the equity issue that um that's absolutely a contributing factor so as part of EMS education we have instructor coordinators and typically the state training coordinator works with those instructor coordinators to make sure that the quality is of education is where it should be in the access to education is where it should be and during the period of time where we had a state training coordinator we did start working on um some of those those problems that is an area that the EMS advisory committee did identify a significant void as a lack of kind of consistent leadership in the state training role so there are areas of the state that don't have instructor coordinators at all and by lacking that um qualification that makes them ineligible to host classes so you know there are entire districts that don't have the ability to host classes even if we gave them the funds at this point um Rob LeClaire thank you um so Drew you said it the currently the deficit's about 630 000 but that information's a couple weeks old so the it was 630 000 um as compiled for 22 services serving 238 000 people so we have data only from a fraction of the state right and you said that number in itself even was still a couple weeks old so yeah we used uh so this information I got from the Angel Services two weeks ago and it was basing their it was projected losses based on the call volume decreases that we were seeing at that time I can say for our organization it was 10% understated when we projected it out two weeks ago so I would assume that the other services are probably similar to that uh under projecting about 10% so I'm just from a projection standpoint here looks like that it wouldn't be unreasonable think that EMS services are going in the whole roughly the tune of $100 000 a week would that be a fairly close number potentially uh for that subset of services that reported yes so there are a lot of services there's you know 90 services in Vermont that did not report yeah and some of those services are the larger municipal services they didn't report I'm sorry they didn't report correct so they're for example Burlington fire their concerns about revenue are very different because they're a municipal service so if they don't have the the revenue coming in it doesn't affect them the same way as it does somebody like an upper valley or a rescue bank so the municipal departments did not give us projections which is why we were using the number of 22 services and the population served as a as a way to project what that would look like across the rest of the state okay thank you yep committee any other questions all right um we have uh we have a little bit of time now for some open committee conversation um I think what I'd like to do is ask Betsy Ann if you can give us an update on um what it is that the senate decided to do with this topic um and uh in that way we can understand what might be coming for next steps in the conversation thank you hi for the record Betsy Ann Rask legislative council um so I think it was on that last day at the state house the senate passed out s124 which uh was a general public safety bill covering law enforcement dispatch and then emergency medical services and they proposed miscellaneous amendments in regard to EMS and then what they did was they took out the ones that they thought should be addressed immediately in regard to EMS and that's what came over to you in s182 that removed credentialing and extended the ambulance license terms and required the DFR direct enforcement of direct reimbursement to ambulance services what was not included is the appropriation amount um the bill that they were working on s124 would have appropriated 450 000 um from the EMS special fund that was expected to be there for the next fiscal year FY 21 and then an additional 400 000 um from the general fund to go to DOH for EMS personnel training so that bill is currently sitting in um senate approves that's its current status in the meantime the other thing that the senate committee did was to write a letter to the department of health just requesting that the department use the funds that are currently available in that special fund um to assist EMS at that time i think that was a a memo that went out a week ago to the department of health um asking them to use what they understood at the time to be approximately 377 000 for carry forward in the EMS special fund um to be dispersed immediately to EMS providers um i i don't know the current status of what the department is planning to do with that thankfully we have the department here um but um that's the current state of things from the senate side was just that memo requesting that whatever funds are available will be used and then there's just an ongoing um uh request for the general assembly to appropriate additional funds um to go to EMS training thank you Betsy Ann I appreciate the the review so committee do you um do you have any questions for any of the folks that we've heard from uh we could also um dig a little more deeply into any of these issues if you'd like all right nobody's jumping Mike Merwicky go right ahead oh John are you John Gannon are you still having trouble getting your hand to race John has no little blue hand today okay so let's go with Mike and then I'll go to John Gannon uh I'll defer to John okay John Gannon go ahead so we do have people from the Department of Health on our our Zoom call today um is there a is there going to be a response to the Seneca Vops's letter about the use of um reserve funds that's a great question and I don't know whether Dan or Shaila would like to respond to that thank you Shaila um so we did I did respond to the chair um after that letter went out but um Andrew and Dan can speak to the conversation that was had but the EMS advisory council did meet and um as you've heard over the last hour so decision was made there that those funds would be probably better used going towards this statewide online training option um but again I'll hand that over to Dan but I did want to let you know that we did communicate that for the for this job thank you Dan yeah I think I would just echo what Shaila just said is that in the last meeting of the EMS advisory committee we asked them to use the funds for the education I think um uh that it would be a certainly a better usage of the funds it would sustain it's it's the it's the notion of teaching a person the fish rather than giving him a fish uh would be how I would describe it um but I'm certainly willing to to uh to deploy the those funds at the at the whim of the advisory committee if they would like to do it differently we can certainly look at other models and so Dan as I understand so this is for the COVID-19 EMP training program you referenced earlier in your test that's right okay and Drew is the advisory council comfortable with this approach so um I think there's some question as to how much funding is available we were made aware that that that had been spent down to just over 200,000 and we did have a discussion a week ago just over a week ago about dividing that as a direct kind of appropriation to ambulance services and what that would that hundred thousand divided up amongst the ambulance services would mean to the um you know deficit uh that services are facing which would not be significant in kind of filling that void and it was uh agreed by the advisory committee that we would be better to immediately spend that money to you get education up and running in Vermont and you know we're hopeful and I'll certainly schedule another advisory meeting so that we can get that done as soon as we can workforce development was our number one priority based on the needs of the services and I think it's going to continue to be our number one priority moving forward so Drew just so I understand your testimony so you believe the money has been spent down to about 200,000 but and you said you wanted to split between training and a direct reimbursement to the various EMS services or are you just wanted for training I just want to make sure I understand what your recommendation is so the committee does not recommend that the money as a direct record or a direct payment to EMS services that question was committee said no the amount of money would be better used to prop up workforce development and it is our belief that there's just over 200,000 dollars to 370 that that was available so can Dan or Shayla explain what the balance is in the reserve fund as of today sure so um I'm going to get a exact number also Senator White wanted an exact number from us on what is in that now I have of course what it wasn't it on July 1st 2019 but that was useful so I'll get that in an email to the chair for the committee so do you believe it's been depleted from 370,000 to something less than that no I don't think it's been largely depleted I think it is around that number but we will get you an exact number all right thank you very much thank you John for those questions Rob LeClaire and then Mike Marwicky thank you Madam Chair I guess I got a couple questions around this I guess it's a matter of priorities here but I'm hearing that we've had ambulance services that are real fiscal difficulty and it would seem to me that we're better off to address that issue even at best here what I've heard here today is about $1,000 a week and I recognize we're talking about a limited amount of money here if continued education isn't going to really be needed if you don't have that you have to continue to educate and does the health department or any other agency have some short-term funding options available here going forward because let's say this continues on for at least another month what do we do we know and I I don't know if it would be Sheila or Dan could weigh in on this sure so I'll give it a shot and hand it over to Dan so as you heard Drew say earlier we have been pushing out all of the different federal opportunities that have been available not just to EMS but also to other small healthcare providers and I do want to take a minute to step back and say that the issues facing EMS are unique in that you know they were already having problems particularly with recruitment prior to COVID but that small healthcare providers across the state are struggling in the same way due to much decreased volume in patient care so this is not only affecting EMS providers it is the same thing I'm sure you're hearing from constituents across the state and other healthcare settings there are multiple different ways in which providers can apply for funding and we have been pushing those out to EMS agencies so they're aware of those different funding streams and as you heard Drew say quite a number of them have applied and received funding so that's sort of what is happening right now on the ground going forward we do need to come up with a new way in which to reimburse EMS that is something that has to happen in the future as you've heard Dan say and we are going to look into that and try to think about creative and new ways to do reimbursement we are also monitoring EMS agencies and the EMS program is sending out surveys and getting information every week from the agencies to ensure that we know what is happening on the ground for them so those are the things that are happening right now in terms of you know the federal money as well as Medicaid money that can be applied for and then also the monitoring and coming up with a new strategy going forward the funding that is in the EMS training fund at the moment again the health department is open to other options but it was the advisory committee's recommendation that we are basing this on that it really be best spent on training as I continue to be a big problem-facing agencies across the state that's a good question. Drew did you want to jump in with a response on that? Why are you going like this? Yeah one of the not necessarily on the longer term one of the short term discussions that we have had and we did request really on the provider tax that is due from amulet services on the 1st of June and we received a notification back that the amulet services are still required to pay provider tax but that provider tax penalties will not be enforced the challenge for services is that under the Paycheck Protection Act they cannot have outstanding tax so for example our service we did receive the the paycheck protection and now we're going to take 50 just over 50,000 of that and send it back to the state in order to make sure that our tax liabilities are met so that we can keep our paycheck protection money in the short term so if we could do anything to delay those as opposed to just within the penalties then I would make at least short term funding for amulet services a little bit easier. All right thank you. Mike Marwicky. Thank you Madam Chair. This is the general question for you and for the committee. We're faced with a statewide problem here I feel and we're also faced with the concerns of the Senate that we're going to have to balance what we're doing and I wonder since other committees I think are doing this now if at some point it would make sense for us to hold a joint committee hearing with our counterparts in the Senate on this topic. So we do have plans to do a joint committee meeting with them on a different topic and so depending on how that meeting gets scheduled we might be able to find time to do both topics. So I will defer to Senator White to let us know once she has scheduled a joint meeting what she thinks we can do in terms of broadening the conversation. This topic goes beyond the purview of government operations and very solidly into the appropriations committee. So we can make a recommendation but it is going to need to be weighed by also by the the appropriations committee as well so we should continue to dig into this. And that's why I understand that and why I think it might be expeditious for House and Senate gov ops to get on the same page so it can get over to to approach and the other any other committees as soon as possible. It's a good a good suggestion thank you. Jim Harrison and then John Gannon. Yeah thank you. Tomorrow we're likely to pass what I think it's 182 and it includes a provision in there for some emergency borrowing from county funds for the sheriff departments. And this may be more of a question for Nolan but to get through the crisis and then we can sort of sort things out going forward. Are there any funds that we could give authorization that ambulance services that are you know maybe didn't get the payroll protection program or have some other extenuating circumstances could borrow from to make sure that we don't all of a sudden lose some of these regional services. For the record the only thing with the joint fiscal office prior to hearing what I just heard Drew say about some of the 377 thousand dollars already being spent. There were some conversations that were being had offline on the Senate side about asking H.S. to use excess receipts from the fund to get some of that money out. I've also heard that but that was prior to hearing the conversation that the EMS advisory committee felt that that money should actually be used for training and not towards helping them stay afloat. So the question becomes are we talking about money to get money out immediately for training or are we talking about getting money out to keep them afloat. If we're talking about training then the money is there in the fund to do just that. In addition to that keep in mind that there's 377 thousand that was a carry forward. The fund also generally gets $150,000 a year. Now whether that money comes in or not in a post COVID world it's unclear because that's money that's taxed or taken from insurance it goes this whole process but essentially comes from insurance companies. So in theory that $150,000 is also on the table but that also falls under the existing process that Dan can probably talk better to about how that money gets out and then in gratitude there's been conversations and I think Representative Cordes expressed some level of frustration over the bureaucracy of it but having talked with Shayla I understand what's going on there. The second part of that question becomes if it's talking about trying to get money out immediately. Part of the CARES Act gave Vermont $1.25 billion to help hold on hush by my dog barking. $1.25 billion a bucket of money that's going to be used to help the state for various things. There are some restrictions on that but they have more to do with can't be used to plant revenues or money that was already appropriated etc etc. That said $1.25 billion sounds like a lot of money but we have a lot of other pressing things as well in terms of the Education Fund and other pieces that are also sort of vying for that dollars. That said it doesn't sound like EMS needs gazillions of dollars so one of the things or conversations that had been had in Senate Gov Ops I don't remember if that was in the letter or not I bet you can answer this but was about sending a letter or how that money is going to be distributed is still a conversation that's happening at joint fiscal and others in terms of how the money gets prioritized for the various things. Is it appropriated? Can the administration just do it? Nonetheless there are processes in place and making it a priority for the appropriations folks saying that when we put money out please make sure that EMS is a priority to us please don't forget them and make some kind of recommendation. That's an avenue that can be done now that's not an overnight answer but that's something that can be done through the appropriations process. Just sort of this committee making it a priority when you make your priority recommendations to the House Appropriations Committee. So those are my immediate suggestions that I can think of. Does that answer the question? It's as clear as you know that stuff on the road when it's springtime and it rains. Gotcha clear as mud. John Gannon? Yeah I got my question answered I mean I mean if we do have EMS services that are potentially going to be disrupted I mean we should try to use some of the CARES Act money to make sure that those stay in business. Absolutely it's a good very good point. All right let's open this up for any committee discussion any further questions further research you'd like to do? All right I am not seeing any little blue hands or any real hands raising. Okay so that finishes our exploration of the EMS funding issue for today. So I want to thank the folks for being with us thanks to the Health Care Committee folks and also the Department of Health folks. Mike Merwicky has one more question. Madam Chair it's a process question and as somebody who is a visual learner and a slow processor with verbal information, verbal sharing of information we took in a lot today. So I'm wondering if we could set some time aside at our next meeting to follow up for committee discussion on this? Yes I certainly think we can do that we can make as much time as we need to review this we do have another committee meeting scheduled for later this week and we can spend some time in discussion if you want to reach out to your own local EMS agencies and get any on the ground updates from them please feel free to do that and also I just saw an email come through that we are tentatively scheduled to have a joint committee meeting with Senate government operations on Friday at one that is not it's not technically on EMS funding issues it's it's actually intended to be an update on elections issues but I will ask Jeanette if we can spend some time having a conversation on Friday on this one we're done with elections so so stay tuned we will come back to this topic any other questions for any of the EMS related witnesses we have with us today? All right I'm not seeing any hands so it looks like we're good to go so thank you to Drew and Shayla and Dan for being with us thank you Representative Durfee for being with us and helping us understand the work that the House Healthcare Committee has already done on this topic we will continue working on this and welcome any of you to follow up with us via email if you have any other thoughts or information you think we need so thank you for being with us today we're gonna shift gears to another topic now so thank you super oh there's JP hi JP excellent great okay so we are um I'm gonna go ahead and unmute you all just because I like the fun of that um we are going to have a bill to present on the floor tomorrow so John Gannon is going to be doing that that floor report do you feel like you have everything you need John? Yes I think everybody's comfortable with the direction of S182 today I mean I didn't hear anyone ask an amendment to it or anything like that so um and hopefully in all House caucus I can answer any questions or concerns people have with the direction of the bill are you sure you can handle it it could be a little more complicated than cannabis? It could be I mean it has three topics you know it has you know EMT you know plumbers and electricians and sheriffs so yeah it's a little more complicated but no I mean people may have questions about it but you know I think you know what I can say about you know continuing funding for EMS is that we heard testimony today about some of the issues around that and we are going to continue to follow it um yeah I understand we're having a caucus of the whole tomorrow right at 1030 yes and you'll be touching upon this during then and then we'll have a floor session later in the afternoon I assume so yeah great well I would imagine that other members of the body are hearing from their EMS services as well so um so yeah probably being a bit proactive in in letting them know that we have heard this testimony and we're going to continue working on it would make sense yeah um Sarah do we um going back to Mari's suggestion about the committee report I assume she was talking about the DFR report on 182 do we need to do a floor amendment on that so Betsy Ann has an answer to that hi uh in regard to the DFR report back it's to the committees of jurisdiction which are in the bill the GovOps committees and the healthcare committees both house and senate so the DFR would go back to both house GovOps and house healthcare okay so they're already covered thank you great all right any other questions committee members all right let me just get a couple of updates for you um so we had talked last week and possibly two weeks ago I don't know the days I'll run together for me I don't know if they did for you we had talked about the issues around quasi judicial proceedings and and that some municipalities were were having trouble moving forward with certain kinds of proceedings because of the statutory requirement that there be a an in-person or on-site inspection or um or meeting location so um I think given that the senate did not um did not send us that language with the bill that they're sending over to us now I think I'm going to suggest that we move forward with creating a committee bill that we can um work on at our next committee meeting and then be prepared to to vote out so if you um if you need to review that language it should be on our committee page under Tucker Anderson because I believe that he did that drafting for us so if you want to review that we will come back to that later this week with the intention of moving that out and if there are other uh COVID emergency provisions that you are hearing about that you think we ought to consider along with that um this is a good time to to talk with legislative council about getting something drafted to put before the committee and also please feel free to give me a heads up so I know it's coming um so any thoughts questions ideas suggestions concerns I'm not seeing anybody jumping all right good deal all right so I will see you all on the giant all house um caucus tomorrow to review bills and then we'll be of course on the floor session and I just want to say congratulations to you today because I didn't put your hands down for you today because that's not the way we do it when we're we're following floor protocols and you guys picked it up immediately I I just have to say though also that watching the floor session last week um uh I I felt a great sense of pride at the um the fact that there were no technical difficulties among the members of the government operations committee in executing our floor session last week not that it's a contest but I was noting that some other committees chairs had some people who were having trouble it wasn't a contest but we won well I think we had some we had more practice than some of those other committees and there are two technically challenged folks from our house and we had less practice than some of the people who had some significant problems some were some were verbally challenged as well oh yeah I thought that was just exercising you know some rather colorful um vocabulary Mike Rewiki and Marcia Gardner have their hands up go ahead Mike I want to also congratulate our committee because none of us dropped an F bomb just remember we're still on live stream so it was out there for everyone to watch not it's not over yet um Marcia so thank you madam chair I just want to ask if we will be taking up s344 at our next meeting so we do need to start talking about that we've looked a little bit at at the language that is in that bill um the Ways and Means Committee is also going to want to have a look at it because um it does reference the state education tax as well as municipal taxes and there may be some concerns around the impact to state revenues by allowing municipalities the freedom that is that I believe is granted in the current version of that bill so so yes we will take that up again at our next meeting thank you anybody else have a question excellent all right well that was a fairly efficient um meeting today I appreciate everybody's attention we've got a lot of floor time sprinkled into our um the rest of our week so we'll um we will see each other in the massive scrolling through of 150 something members uh starting tomorrow so if there aren't any other questions or announcements I think we'll go ahead and sign off great thank you thank you great all right see you later


Here we go, Thorsten Schröder, THS. Hello, you're very brave to still sit here in this weather. My name is Thorsten Schröder. I am a, I started a while ago to think about open source licensing, free software licensing. And I asked myself how contemporary the currently in use open source licenses are with regards to our open source code being used by the military or by intelligence services or by large corporations who are abusing the code for their own nefarious purposes. So how can we prevent misuse or abuse of a code? And that's all I want to start a new discussion about that has existed in the last 10 years. So what drives a developer to publish his code, sorry to publish her code as open source, free software so other people can do something with that? So maybe the developer participated in open source projects in her youth, maybe have developed something and now wants to give back to the community. So usually developers are driven by something good. So usually developers want to make sure that the code is not used for nefarious purposes, like military uses, intelligence services, basically anywhere that puts people at harm's way. So the first discussion, first part of this discussion is the events we had this year where we can think about hacking team transparency report in July, where hacking team, the Italian company that sold surveillance software to repressive regimes and governments to infiltrate their computers and exfiltrate data and audio recordings where people are then being abducted or just disappear. So definitely people coming to harm. And not all of that is released by them. So this example, for example, hacking team used code from Colin Maliner, who built a tool to debug Android systems on the ARM platform. So he built a platform and this framework is being used here. So after all the source code of hacking team landed up on GitHub after they were hacked, people started looking through the data, through the source code and see if their own names appeared in some form of ego googling. And that's how they realized it. For example, Colin Maliner's code and also code from FIFA and the ad guys, people from CCC, from DietLiveC specifically, has been used by a hacking team. And that is the starting point for this debate. At first, I thought to only do a lightning talk, but it's actually more complex because there's plenty of problems that makes it not as easy to simply say, let's extend the GPL with an exclusionary clause. So in the beginning of this year, I started thinking about this problem. And I saw DAPA release a press release about an air support system that they developed in the base of Android where basically the Air Force that uses manned and unmanned vehicles, they can simply get target calls from troops on the ground using an Android tablet. So they can basically touch to kill on the touch screens.  So here it should be obvious that Linux kernel code and other open source projects are being actively used to kill people. And that cannot be controlled at the moment. I took this event as an opportunity to write up one clause that I could add to my favorite license. I've done a lot of stuff with the BST license. So I thought let's just try and create a exclusionary clause for BST. It's not as easy. I'm going to go into more detail that later. But that's a discussion we do need to lead again. It's pretty old. It's been discussed more than 10 years ago. In the Free Software magazine, there is an article from 2012 about the same issues. They come to a different conclusion than I do here. But in this article, too, there is a rather long list of open source projects that are explicitly used in the military or made for explicit military use, some of them very generic like GCC, Linux kernel, GNOME, but also open source projects that are expressively created to be used in military situations. Obviously, that's lots of them are software projects that deal with mapping data, with coordinate systems, and so on, simulations, solid modeling. So very specific tools that are used by the military tool for each war. And the conclusion of this article is that we cannot prohibit the military use, and we may not do it either because that's the law. So we're talking about a law. The definition of open source forbids it, and we don't want that to change. So every developer has asked herself how far can we take liability for our own code. Independently of a license, whether it's GPL or anything else, many developers have thought about what happens if my code is being run on medical devices, for example, or in nuclear power plants. And a bug that I created is responsible for the deaths of people or for screen stress turning off in the middle of presentation. So that's not really about a license in the end, but people have been thinking about that. And it's much easier to just distance themselves from military uses, from weapon systems, or from having a code used for repressive tools, or repressive regimes, like in the hacking team case for example. Everyone has thought about that kind of responsibility. And this is about ethics and philosophy apart from licensing. There is one group of developers who have thought about it in 2006. They later called it the pacifist clause. The project was called GPU, the Global Processing Unit, a Nutella client that allows users to share CPU resources with other people. And they extended the GPL with the following. The program and its derivative work will neither be modified nor executed to harm any human being nor through inaction to permit any human being to be harmed. So a reference to Asimov's three laws of robotics. And they tried to ensure that this code that was obviously had its military uses could not be used by the military. And they have no way to actually control that or enforce that. And there's a argument of people opposing these clauses that you can't control them. But such a statement allows us that in case we learn of such a violation of the license, that we can start an open debate. So what reasons do we have against extending licenses? Why don't we have these clauses already? One big reason is Richard M. Stallman, who vehemently argues against these kinds of clauses because he says that that would make the software unfree if we would exclude some part of the state and the military to use the software, parts of the software. So Stallman wants to limit the developer's freedom to limit others' freedom. It's hard to discuss this sensibly with Richard Stallman. He also said he would find it very sad that if his friend who works for the Venezuelan military could not install any more Linux servers. So he says something needs to be free. And that is freedom as in total freedom, where freedom number zero is the freedom to run the program as you wish, however you wish, and for any purpose. So for any purpose that clearly includes killing other humans, surveilling other humans, propagating oppressive regimes. So that's his view on software. And I think in today's time we should definitely think about whether that is still appropriate for this time and age. And we are having some technical difficulties here. Please stand by. In addition to these principles of Richard Stallman, there's also the so-called open source definition and open source.org. HNA paragraph six says that we may not exclude certain groups of users. Paragraph six says no discrimination against fields of endeavor. So we may not limit our users. That's the open source definition says. But possibly we should change that. So as opposed to these exclusionary clauses, I already made that point. They just say the software has to be free. But I think by now we're at a point where we can rethink that issue. And I think if states can change the regulations, I mean, we should be just as enabled to change our software regulations. This is a way of ensuring or at least trying to make sure to make it, well, not as easy for the people who rely on our code to make the risk higher, to make punishment or legal enforcement possibilities simpler. But in any case, we should be enabled to exclude certain forms of usage with our products itself as soon as we deploy them. And this is the idea of a non-military usage form. So when I read this DARPA news item beginning of last year, the idea that I had at that time, I thought this might be for BSD, an exclusionary clause. Well, maybe I was a bit naive. And I wasn't really aware that there was even so much opposition from within the open source community. So this is the text I wrote. With that, I only want to exclude that one certain developer is less important to make this not always a matter of national security concerns. So it can be on several levels. It doesn't have to be that severe. But I do like the visual effects here on the screen. But there are many limitations for this. The GPL, for instance, does exclude that you actually can exclude anything. And this draft that I had, the first draft, this is still on a quite easy level from terminology. But there are boundaries. There are some people who say, well, I don't want my code to be used from the police or from the government either. And well, I'd say, well, that's something everyone should be able to decide for themselves. But the problem is, where is the exclusion mechanism? So you have to have a clause that can be more or less concise, that has, well, is legible and just something which is apparent. And if we don't note this or formalize this in a very concise form, well, no one will really take note. And so I think it's quite simple to, well, find boundaries towards the military. Where does that start? That's quite straightforward or obvious. But maybe some developers won't have less problems, maybe with the intelligence companies. Well, but that remains to be seen. And how can we now actually put that into action? Well, will Richard Storm and Preventus from actually modifying the license? But we could have maybe another approach. There's something like creative commons, which I tentatively called coding commons. So just in the terms of the code we use so far, be it GPL or whatever. Well, more characteristics attached to a project that can be like modularly mounted together from different, well, this is an amendment and not a modification really of the GPL, but the kind of idea that you can add on in modular form. Well, this would be a kind of code commons module, which you could just write down and attach this to your, well, the main attributes say it's non-military, non-intelligence or consents required. So if I write the code, the hardware that it's going to be used on then finally is the user of the hardware actually aware and willing to have this code executed on the machine in question. But this can be in the matter in embedded devices, but similarly, the users have lost control about what's phoning home and have less possibilities to configure and modify themselves. And so that's something which isn't really desirable from the user side. And so that's what the consensus idea is for. And for everything else, I put the X for instance. So whatever that may be, you can specify, be it healthcare or I don't want it to be is for automotive. But here again, we have the problem that it's quite challenging to find short and concise definitions. So maybe I made an audio codec, which is used in a vehicle at some point later. And well, in that manner, I could be compromising the vehicle security with the delay. And so this is why it's important to rely on these user agreements. And so the enforcement, although the consequences have to be, well, obviously you have to find out that someone is without the regulation, but so the enforcement or the punitive means aren't quite that clear. But you can, of course, take this to court and sue and maybe enforce, well, publication of code or just make the punishment part of the contract itself, which would be a kind of fine payment in the end. But this could be a well in the area of about a million to make it interesting and to make people more compliant in these terms. So I think it's not worthless to actually try and define these quite concretely, but at least I do hope that we have a more public debate about these issues. So even if maybe there was a court case and a judge saying, well, we still want to make Bill send our rockets around with your code. Well, then at least we have the situation that there are being rights and negotiations made. And I think that's the overall target. So I think we should think about the possibilities that we have to realize or to at least outline something like this coding commons idea. And that's something that a lot of coders which should sit down to around a table or a mailing list, whatever, and maybe to find a way to talk about this, maybe even to present something for Congress at the end of the year. So just to outline what makes sense, what is possible and what is legal from various perspectives. And I'd just like to encourage you to think about this, about the possibility of these exclusion clauses, especially in security area, exploit and bug bounties or tracking due diligence. There are possibilities to prevent a certain companies from using this and can ensure that this is just transferred on a more immediate basis. And so if you want to take part in this discussion, do please write to me an email. You can see my contacts here and there is no finished concept but I just wanted to put it out as an idea and I'd like to really like to discuss it with you further.


My name is Joanna Millington. I studied online at Griffith University. I work full-time at a creative agency and I also had three kids, a husband and a puppy. Knowing my lifestyle and kind of how much on campus time I would realistically have, I started looking at options that allowed a lot more flexibility. Griffith was the obvious choice. Within each subject there were six modules and each module consisted of a range of videos and lectures that you could just download at your leisure, but it also included a session with your lecturer. That's what made it amazing online because I could just study when I could fit it in. What I really loved was the support I got from the support staff. They would kind of be my cheerleaders. But what really excited me was the calibre of lecturers. So it felt like Griffith were giving me the lecturers who weren't afraid to teach in the format. Support services available to me were things like alumni services, technical support, mentoring, so there was plenty of mentoring available. And the library was also a fantastic resource. We were also able to use a platform called Teams, which is a way of communicating with a relevant group of people. Lecturers, support staff and the peers in your subject that you were studying with, I felt like I was part of a traditional class. Advice for students thinking about studying online, just do it. I couldn't have asked for more.