The folks who are here, so you get to know who we are and then as we take your testimony, we'll get to know who you are Rich Westman the senator from the mobile Senator Ginny Lyons Chittany County getting in from Chittany County and coming in late will be senator and Cummings from Washington County and senator Dick McCormick from Huh? Windsor folks, okay, this is good. So I understand that Marie Wood the director of familial cancer program hematology oncology division for UVM would like to be on the phone So we're going to put her on the phone so she can listen to the testimony and she will also be providing So we are on s197 and Damian. Did you want to just show us what we have for the latest draft? Briefly or do you Let's do that really quick just the sections that are new the sections. I think there's just a couple of them, right? Yep, just four changes Okay Four sections that are changed Good morning, this is dr. Wood Yes, it is This is senator Lyons You are here in the health and welfare committee room with members of the committee and other interested folks and We're happy to have you on the telephone You'll be listening to the testimony. Can you hear me? Yes, I can perfect. Okay. So and then when it's time, we'll ask you to offer some testimony as well Thank you. All right. Thank you for being here Damian great. Good morning for the record Damian Leonard legislative council So I believe all of you have on your iPads the draft 1.1 of a proposed committee amendment That I draft it up And so what this would do is it addresses some of the concerns that were raised the last time we talked about the existing language that permits the use in the statute that would permit the use of Genetic information that was in an individual's medical record regardless of whether there is an actual Physical or medical condition that's resulted from the genetic predisposition of that condition So the first is in section three. This is in the genetic testing section of the health law And it it is a general provision that prohibits insurance Offered or issued in the state being underwritten or conditioned on the basis of and currently any requirement or agreement that the individual undergo genetic testing Or the results of genetic testing of a member of the individual's family and this would modify it to add Genetic information of the individual that may be associated with a potential genetic condition in that individual But that has not caused a diagnosed condition in the individual Or the genetic information of a member of the individual's family and so it's broadened the Reference for the family there to genetic information generally and then it's addressed the issue of if you haven't identified Genetic information in there, but it hasn't resulted in a diagnosed condition The one word that I would note that You may want to consider Changing here, and I don't know if this is necessary. It's just a question for those who have more expertise is the word caused Because I I don't Not being a doctor. I don't know caused is the right term Is it a cause effect or is it that the condition is manifested or some other phrase there? But that's just something to flag for consideration The next change is in section 4 now. We're getting into the insurance law the changes to section 4 5 and 7 are there the second third and fourth instances of amendment and they're all essentially the same change and What we're doing is the same as we've done above we're making the language consistent with that so genetic information of The individual that may be associated with condition that has not manifested itself Cannot be considered for purposes of conditioning insurance rates or the provision or renewal of insurance Or certain coverage or benefits And then we're clarifying I actually we're just keeping consistent the genetic information of a member of the individual's family And that change is consistent throughout the only other changes in here are just updates on cross-references and deleting language that allowed results of genetic testing or genetic information that would of family members that was contained in an individual's medical record and Keep in mind genetic information that definition covers things like a disclosure that your family has a history of heart disease or Of other certain So Those are the changes Six pages but so we had talked about this last time and thank you for bringing this to our attention I think that's what we're going to be hearing about today from a number of folks. So this is helpful. Great. Thank you Okay Deborah Leonard is here. Thank you It's good to see you again Good morning, Senator Lyons and members of the Health and Welfare Committee and the special good morning And thank you to you senator Ingrams for sponsoring the bill that brings us together I'm Deborah Leonard and I'm here today to ask for your support of s197 a bill that would protect Vermonters from discriminatory practices based on their genetic information By way of introduction I'm currently chair and professor of pathology and laboratory medicine at the University of Vermont Health Network and The Robert Larner College of Medicine at the University of Vermont In addition to my medical training as a pathologist I have a doctorate in molecular biology, which is the study of genetic material used to control cell and body functions My medical specialty is called molecular pathology or genomic medicine Which focuses on testing of genetic materials specifically DNA and RNA for medical purposes Including for cancer infectious diseases. I will not be talking about Inherited diseases I have practiced for 28 years and seen major advances during the course of my career Including testing advances that allow us to know the genetic sequence of an individual person's genome For medical purposes for research or even for an individual's curiosity about their Genomic information. I've served on national genomics committee Committees advisory to the Secretary of Health and Human Services and the National Academy's Genomics Roundtable In Vermont, we're transitioning our health care and payment models toward prevention of disease to keep people as healthy as possible Overall health and well-being are determined by many factors About 60% of overall health and well-being is determined by social determinants of health Such as education level Income which can determine access to housing food and medical care and personal behaviors such as exercise smoking and diet Medical care only contributes about 10% to overall health and well-being The other 30% is determined by individuals genetics yet We do not routinely use this information in health care The University of Vermont health network is changing this on November 1st of last year We began offering genomic testing to our patients through a few of our providers So we can begin integrating genetically determined health risks into the care of our patients While we often think about genetic diseases as rare conditions Diseases are associated with approximately 6,000 of our 20,000 genes and the World Health Organization Estimates that single gene genetic disorders affect about 1% of the world's population And this doesn't include diseases that are caused by a combination of changes in multiple genes Knowing genetically driven disease risks before the onset of symptoms can allow us to monitor for disease onset To identify the early stages of disease when interventions may be more effective and To provide appropriate treatments because we will have a diagnosis I would like to share a personal story My husband Greg Merhar and I gave each other our genomes for Christmas in 2014 and received our results in 2015 Now we're really nerds Greg's genome showed genetic changes that cause a rare genetic disease called familial Mediterranean fever or FMF We realize now that Greg had symptoms of FMF since he was a teenager But the symptoms are not very specific although rather severe and include extreme abdominal pain slow healing from injuries and general aches and pains Over his lifetime Greg underwent many medical studies and tried many over-the-counter remedies But nothing worked to relieve his symptoms to our surprise We found out that FMF is treatable with a drug called Colchicine which is also used to treat gout He says he met me so he could get a diagnosis and feel better His primary care physician has patients with FMF But didn't think about FMF as a cause for Greg's symptoms because Greg does not look Mediterranean He has blonde hair and blue arms Genetics also can help physicians consider diagnoses that they may not otherwise consider Unlike Greg and me who were just curious and bold about learning our genomic information many people fear the misuse of their genetic Information so may not agree to have genetic testing to inform their health and health care The Federal Genetic Information Non-Discrimination Act also known as GINA passed in 2008 Only protects Americans from health insurance and employment discrimination Based on their genetic information, but does not protect against other forms of discrimination So Vermonters may see the risks of genetic discrimination as greater than the potential health benefits and not agree to have genetic testing to inform their health and health care S197 if passed would more fully protect Vermonters for most any type of discrimination Based on their genetic information as we move forward with broader use of preventive genetic testing And proactive genetic testing these protections will be important for Vermonters to benefit from this advancement in health care Thank you Thank you. Do you have that electronically so we could put it up on our I do Got a lot of data in there things have changed since the 80s and 90s People used to say you're 85 genetic and 15 environmental, but A lot different today. Yeah, and the 30 we don't understand all of that 30 yet But what we're doing is sequencing genomes and then going back to those over time So it's not like a usual test that you do once And and and you'll do over and over again like a cholesterol level Your genome won't change so we can sequence it once and then just revisit as our medical knowledge Or your symptoms change Questions I didn't know whether there would be any questions And you're I hope your genome turned out okay mine is boring, but I think having a boring genome Better than having it enough All right Leah Burke Thank you And good morning senator liens and the senate health and welfare committee My name is leah Burke and i'm here today to ask you for support for s1 19 And raised by senator ingram. Thank you A bill that would help protect vermonters from discriminatory Practices based on their genetic information I'm a clinical geneticist And for the past 20 years have been the head of the clinical genetics program at what is now the university of vermont medical center And health network I'm also a professor in the departments of pediatrics and medicine at the larner college of medicine at the university of vermont Where i've taught genetics and genomics to medical students residents and fellows in training Nationally, I chair the council on genetics for the american academy of pediatrics Within the genetics program at the university of health from on health network I examine diagnosis and treat patients with suspected or confirmed genetic conditions As part of that I do mostly diagnostic genetic and genomic testing But the family history is a very important tool in the work that we do And therefore the clinical care extends to that family Once a genetic diagnosis is made in a patient There may be clinical indication to test other family members For instance Sometimes if a condition is caused by two genetic changes in a gene The parents need to be tested to determine Whether those changes are in the same copy of that gene or on each of the copies of the gene That helps in our treatment of the child or a person that has been diagnosed Additionally because of the variability in the expression of a genetic condition A parent may actually have the condition without having the same signs or any signs at all as their child Having this information is clinically important for the child as well as the parents to give accurate recurrence risks Therefore we often place genetic information in the charts of unaffected individuals In addition the family histories that we place in a patient's chart often contain genetic information About their family members As I mentioned a family history is considered an important As important to a patient's care as the past medical history My position also involves overseeing and collaborating with genetic counselors The genetic counselors see individuals with conditions that are thought to be genetic for diagnostic testing They also see patients and families for counseling Around their family histories and possible genetic testing based on those family histories We provide counseling and arrange testing for the persons coming in And also for members of their families Most of the time the individuals seen for genetic counseling. I'm sorry Coming seen for genetic counseling and tested for that Because of a family history are adults There are recommendations against testing minors for adult onset conditions That run in the family, but as in much of life there are exceptions that need to be made For example, we have babies or young children who are going into the child protective system Or being placed up for adoption who have a known genetic condition in one of their parents It is in the child's best interest to have as complete a medical history as possible in those situations So genetic testing for a later onset condition may be done The child is not symptomatic and may never develop symptoms But will need to have specific monitoring Done to look for the symptoms that may appear Without the genetic testing information the family history may be lost or misinterpreted And the child may have a delay in diagnosis In particular one child had a parent with a hereditary cancer syndrome The child was tested and found to carry the cancer predisposition mutation And therefore will receive earlier screening than they would have with a general population risk The patients and families that we see want to know their genetic risk So that they can have proper screening and make life and reproductive decisions Their family members genetic testing results are placed in their chart so that the laboratory is doing the testing can provide more specific and accurate testing Even if they decide to wait on genetic testing the family result is often placed in their chart They need protection against discrimination for their own pre-symptomatic testing result as well as the results of the family members We have found that having genetic testing results allows for a more specific diagnosis that in turn Allows us to give more accurate prognostic information and screening practices And allows the families to participate in clinical trials Having the ability to test and family members who are not asymptomatic assists us in that effort Finally, I'd like to say a word about newborn screening programs Newborn screening programs, Vermont's included, now include conditions that involve genetic testing And may have a later onset For the traditional new born screening conditions such as inborn errors and metabolism The tests done were primarily biochemical and not genetic and treatment was initiated right away With the new conditions such as spinal muscular atrophy, Pompeii disease, and excellent adrenal leukodystrophy The testing done upfront includes genetic testing And in these conditions the asymptomatic period can last for years and treatment has not begun right away So now we have a public health initiative that automatically does genetic testing in the pre-symptomatic phase of disease A public health Initiative that automatically affects all children born in Vermont and may have an adverse effect on their insurability You were given a handout Containing the informed consent that we have all patients or proxies signed before proceeding to with genetic testing Informed consent is required by both Vermont and New York where we also have a lot of patients As well as most of the clinical genetic testing laboratories that we use The last paragraph in that consent warns against the discrimination that may they may encounter as a result of the genetic testing We are recommending It is my hope that this bill may result in our ability to eliminate or at least alter that paragraph I applaud your forward thinking in proposing s 119 And expanding the protection against discrimination to include genetic and genomic information And I would be happy to answer any questions So this the informed consent that you have folks signed really What happens when someone sees this and reads it? What are the responses? That that's a very good question As with much of informed consent not everybody reads all the way through it Our genetic counselors and I try to also bring up those issues when we are counseling patients Some patients decide not to have testing because of the risk to insurance. That is absolutely true Some feel that if it's a child, they will get interns in place before they have genetic testing That's true even for themselves So and and Some decide to go ahead and hope for the best What if if folks paid for themselves what what's kind of like a ballpark figure about how much it would cost It really depends upon the testing. So if we're doing a single gene, it's usually Around six or eight hundred dollars If we do a panel of genes, it may not be much more than that because the technology involved and Dr. Leonard can speak to this better Is not much different in doing one gene than many genes because they're done in a massively parallel sequencing So but if you do a large panel or an exome, then you're talking several thousand The price keeps going down, but it's still a burden for families, obviously So a question for dr. Leonard probably and that is uh, we are doing this testing locally Yes, some of it. Yes, and uh, but often partnering with companies who share our values and mission of bringing genetics into medical care So the laboratory that does it is at the university for cancer testing pharmacogenetic testing and rapid diagnostic Exome or genome sequencing when we are or will be doing that at the laboratory at the university of ramot medical center For the rare diseases That's really taken care of by large or genetic testing laboratories that receive samples from all over other questions for dr. Thank you This is like taking a Grad course, right? Dr. Wood I have you on are you still online? Yes, can you hear me? Yes, we can and we would welcome your testimony Okay, thank you very much. Um, good morning to all of you and again Thank you for allowing me to testify in support of s197 by phone I do believe that this bill could help to de-sigmatize genetic testing improve care for patients with inherited cancer risk and potentially save health care dollars, and that's how you buy I think that As you know, my name is marie wood. What you don't know is i'm a medical oncologist and clinical researcher I have been at the university of ramot for over 20 years My clinical work focuses on breast cancer and genetic And my research focuses on both genetics and cancer prevention I'm a professor of medicine and the associate director for cancer control and public health science at the university of ramot cancer center and also the director of the familial cancer program Where all the cancer genetic testing is performed at the medical center Nationally, I serve as a co-chair of prevention for the alliance for clinical trials, which is a cooperative group Developing clinical trials for patients with And patients at risk for cancer. I also serve on the nci's prevention steering committee and the nci's Central irb that reviews prevention studies For protection of patients rights I have been working in the area of cancer genetics since my fellowship at the university of Colorado, which I completed in the early 1990s I've established two clinical and research programs in cancer genetics one at the university of Colorado Which exists and ones here at the university of ramot when I arrived I've been working with people with inherited this for cancer since the discovery of the rca one in 1994 And it was involved while at the university of Colorado in the first clinical genetic testing for this g I've been I've seen and been involved in considering the impact of cancer genetic testing not only medical But also ethical legal and social impact for the majority of my medical career In the early days of genetic testing we kept Separate or shadow charts for patients undergoing genetic testing a little bit like what dr. Burke was talking about We did this to protect the patients from misuse of their information While we did not understand all of the possible ramifications. We did worry about employment at health insurance With the introduction of the gina legislation, which you've heard about which happened in 2008 More widespread use of genetic testing, which you've also heard about the explosion of genetic testing And this was done for cancer risk and the need for providers caring for these patients have access to the information We were obliged to put our genetic testing information into the patient's medical record That is now our standard practice and provides critical guidance for cancer prevention and sometimes cancer treatments For our patients And this is really an example of how we provide the best medical care If we remove all barriers to genetic test as I've said there's been an explosion in our understanding of cancer Genetics with the discovery of many new cancer related genes We now offer a panel of genes to our patient Genetic testing offers a way to identify risk and take action For example starting high risk screening such as screening breast MRI, which is added on to screening mammography Or more frequent colonoscopy sometimes as common as every one to two years Or having preventative surgeries such as removing almost the entire colon or removing breast tissue The this is most important for unaffected individuals as they may be able to avoid a cancer diagnosis with these preventative actions Currently the uptake of testing among family members when in gene mutation is identified in a family is less than 30% This may be due to concerns regarding the potential for discrimination In fact our group completed and published a national study showing fear of discrimination was a significant barrier to genetic testing among untested relatives It's therefore imperative that we do as much as possible to destigmatize genetic testing Genetic testing for cancer risk has the potential to save hospital dollars I believe just because evidence when you consider today high cost of treating cancer And compare that with the cost of cancer screening For example, colonoscopy, which can identify and remove early pre-cancerous polyps can prevent colon cancer In people with inherited risk for colon cancer Colonoscopy is far less costly than treatment of cancer, although nobody likes a colonoscopy Additionally preventative surgery, for example to remove breasts or ovaries can reduce the risk of breast cancer or ovarian cancer by more than 90% And as you can imagine, it's far less costly than treatment for either of these cancers Moreover, this does not even consider the quality of life associated with avoiding a cancer diagnosis and treatment In closing, I want to thank you for consideration of this important legislation Which I believe as I've showed you stands to destigmatize genetic testing Improve care of cancer patients and may even save health to the dollars And I'm happy to answer any questions you may have Thank you Thank you Dr. Wood, I guess I should ask this to everyone who's testifying Including those who haven't but the question it was brought up earlier as we went through the bill About cause and effect relationship between genetics and what your genetic predisposition is and And actually expressing the disease So again, I I guess I would ask you Dr. Wood to begin if you could with your if you have thoughts on that If not, we can we can let you reflect a little and come back later, but I'm looking also at Dr. Burke and Dr. Leonard. So So I'm happy to tackle that and speak specifically to cancer The correlation between having a genetic mutation and getting cancer is not 100% It depends upon the gene and as lea Burke has told you a little bit about if they also depend upon the family history Our knowledge is Exploding in this regard and really depends upon testing more people so that we get more accurate risk assessment For some people it would may be a slight increase in their cancer risk For others such as vrca one or vrca two or even the colic cancer gene that risk is Significantly greater than 50% and may approach 80 or 90% does that answer your question? Yes. Thank you. It's very good I will we'll look around the room for others later Well, we'll have a little conversation later on about this if unless you'd like to say something now It wording could be instead of cause but has not resulted in the condition in the individual. Okay. Thank you All right, very good. Any other questions for dr. Wood? Thank you very much and again, it would be extremely helpful if we could get your testimony electronically so we can have it on our Thank you. All right good Um So chris rice are you testifying or dr. Bleson? Dr. Bleson is here. He is. Thank you. Why don't you come up and introduce yourself to the record? Is your testimony online? Um, I submitted the one that was written by the acli. I've been sitting here rewriting mine in response to their Excellent. Well, that's good. Okay. Well, this is we need to have some discussion. Yeah, I'm happy to so I'm here Um, clearly dr. Burke Leonard and would have credentials and genetics that trump mine National recognition and leadership of committees that are very important and doing really good work My expertise is in life insurance underwriting I'm the guy who applied genetic tests When the applicant wanted to buy a million dollars with the life insurance and I know how it works And I think that we're actually not that far apart once we get to some clearer understanding I'd like to address at the get-go a couple of diseases they mentioned Familiar Mediterranean fever treated with colchicine has no extra mortality and is totally insurable At the best rate Be our dr. Wood mentioned some colon cancer or some breast cancer genes that People have surgery for we recognize those surgeries as curative No extra mortality So I just wanted to address there are two questions right off the bat and then get to my Testimony Because it's important that people understand how we use information and I really don't have the time to go into Underwriting detail and how we think about things, but I'd love to have the opportunity to talk about it We certainly don't want to interfere with the progress of scientific advances or improvements in medical care We're all in favor of that as I think everybody in the room is As a background I'm a physician I spent 27 years as medical director of Northwestern Mutual Were almost all of my time was either in underwriting or legislative matters such as this I left at age 60 and went to the medical college of Wisconsin as an associate professor and director of preventive cardiology Or half my patients had inherited disease I am currently a medical consultant for the american council life insurers And right now we are working the acli with the national society of genetic counselors on a joint webinar to understand Misperceptions about their work and our work and it's actually a very exciting thing and been Excuse me great opportunities That cough is nerves Life insurers and we're talking about individual life insurance Where people choose when they buy and how much to buy It's not group insurance, which is available for individuals And it's not health insurance where the premiums are adjusted every year In life and individual life insurance the premiums are set at the time of underwriting and cannot be changed at any time in the future Individuals have for a hundred years trusted us with their private and personal information Because they know that that's a how the system works And they know that we have to be able to assess risks So we have the proper money to pay a claim that may not become due for five or six decades We are required by state law to treat like risks in a light way We are not allowed to make to treat like risks differently The states routinely send auditors to companies around the country Where they pull up records and be sure that you followed your rules And they do things like check our mortality results to see that people are falling into the right bucket It is a tightly regulated environment The main goal is that we have the sufficient funds to pay all the claims We may underwrite somebody today and they could hit by bus tomorrow We will pay the two million dollar claim. No questions asked. They may die At age 80 they bought the policy when they were 25 they may die at age 80 We will pay the money and we will have the money to pay that claim We're required to do that and they also ensured we have those monies It's important to remember that insurers are in the business of selling and placing life insurance We do not look for ways to decline applications and When we underwrite we underwrite with the written consent of the applicant They're entering a voluntary contract and they want that contract to be respected on both sides For the past 75 years advances in medicine And testing Help both physicians and underwriters understand disease better and treat it better Life insurance during that time has simply become more affordable And more widely available For example the blunt instrument 75 years ago any everybody with a heart attack was a decline Life insurer wouldn't look at him today heart attacks are broken into all kinds of pieces How much muscle damage was there was how many stents did they have bypass surgery or they on their statins Are the patient's compliance? So underwriters are competitively looking for a way to find a way to sell that patient with a heart attack insurance at the lowest possible rate It's also important to remember That all tests Can help customers including genetic tests Genetic tests today are increasingly part of the medical record And they understand both the physician and the underwriter help understand the disease better There are genetic tests that indicate some lymphomas Barely need to be treated So now we know that not all lymphomas are going to be the same Show a life insurer that information and a life insurer is going to go Oh, I feel a whole lot better about that knowing this genetic information If somebody has a positive history for breast cancer And they come in with a negative breast cancer gene The life insurer is going to forget about the positive family history. That's an important consideration If the patient has the family his positive family history of breast cancer and they have the BRCA gene Now like dr. Wood was saying they're going to start to get More advanced mammograms or better mammograms And they're going to do better life insurers look at that and take that into consideration We also all life insurance medical directors are trained in statistics and understand the probability and The breast cancer genes are never a hundred percent And we understand the disease may not occur for years that helps to lower the rate So it's how we use the information that I think is the missing piece The bill under consideration today would prohibit us from using both genetic test results and family history First that prohibition would prohibit people from using favorable genetic tests And second in those instances where the genetic test indicated a medical risk And we could not know it the applicant we would have asymmetric information And the applicant can then use that information and apply For an increased amount of insurance We know from studies the people who have tests for Alzheimer's and hunting tons By insurance at five times the rate. They also buy larger policies Now somebody the other people of vermont Have to pay that difference And I understand hunting tons is a difficult disease Everybody hates that disease But we can't change the life insurance Industry and the financial protection we provide to vermont families and consumers and businesses In order to Provide protections for one small group only a couple per hundred thousand people Many of the other issues that were raised today. I think Can be By understanding how we actually use that information when we make decisions because I don't think We're as draconian anywhere near as draconian or as Single-minded or looking for reasons to decline. I think we're actually I think we need to have some dialogue and talk about that. So I would love to be part of that The prohibition on family history would make vermont a first in the nation Some people may say well, that's wonderful Um, but this is something that has been an integral part of the underwriting application And when we ask it, we're not asking For the detailed Tests in your brother's medical record What we're asking is does your brother have a heart attack? Does your brother have cancer? That's the level at which we are to mean the family history question So it's not Delving deeply into somebody else's medical records. We were would be prohibited from using anybody else's medical records To make a decision about an applicant Um, and I think that we can accomplish A great deal recognizing that it's important that genetic testing Uh, both be further developed and go forward and used preventatively Life insurers have no interest in the whole genome. It's 23 billion base pairs. We wouldn't have the computer database put that stuff in Um, but I think that we need some clearer understanding of both their concerns and An explanation of what that really means to us Because I think we're closer than Than we might others might think Um, I say that having testified first about genetics in the early 1990s in the state of wisconsin Where somebody's a rip legislator said a drop of blood at birth can determine how long a baby is going to live And we've been going around those and dealing with misperceptions about how we use insurance or are interested in it for a long time So I think I stopped there and I'm happy to answer questions Okay, thank you. So I see you've included something about the state of Maine language Yes, and the testimony That follows at the end of your of the written testimony that we have from you So I I guess the question I would have and I I do want to make sure that we hear the other folks in the room who are here to testify but um, you said that uh, you want to make sure that people Can continue to trust the insurance companies With confidential information and that this might that so my question is Would once um The genetic information is available and part of the record for that individual Should the individual begin to express a disease And require specific types of coverage or it has the insurance industry considered What happens then and how that might be put into Your underwriting process Are you talking about life or health insurance me health insurance? I'm talking individual Well, let's go with life insurance Either one Individual life insurance we have because health insurance is covered by gina. Yes Individual life insurance when we you apply we underwrite using the information we have If your history application is Clean doesn't have any red flags And you fill out a non-medical and maybe get some blood. We're done You've got your five hundred thousand dollar policy if you're applying for a two million dollar policy or you have a history of a prior disease we may Ask to see the medical record We get the medical record and we look through it and see those tests Most of the testing information actually makes us feel better. We're looking for ways to issue the policy Once we and the treatment you have so once you have the policy We can't change the terms or conditions or anything forever It is set in stone. So we have one opportunity to do this. So whatever develops after that Can you put conditions into that type of policy? for health care services primary care Preventive care or not? No We set a price That's it Questions Go ahead. So the so the language in the written testimony that we have is it's really just about These directs consumer genetic Tests right and most other states recently the concern has come with direct to consumer testing So you would be satisfied if that's all what you did then you're not are you asking for Something more. No, no our life insurers are Not interested in direct to consumer testing With the sole exception of that little bold print that says discuss this result with your doctor What we really want is that individual to go to one of these three Ladies who talk physicians who spoke and are geneticists And get that test repeated in an accurate way in a certified laboratory and then correlated with the medical The individuals medical history. So we're not interested in direct to consumer testing And in other states that has been a lot of the driver For legislation But in terms of our bill That that's this is really the heart which we're asking then you're not asking for us to do anything other than Correct then Brave it the direct to consumer Thank you. You about thank you. Thank you very much It's Emily Adams here. I'm going to put you next because I thought that was you. Yes Thank you. All right And falco you are going to be last Good morning. I'm Emily Adams. I'm an assistant attorney general in the civil rights unit of the attorney general's office This is Eliza. She is three months old and she is currently at work with me. Um, so she's joining us today And hopefully she will sleep through this testimony So my job within the civil rights unit Is in it is overseeing our day-to-day employment discrimination investigations. So my testimony today on this bill Will be limited to the changes to vermont's fair employment practices act Which I believe I have the hard copy That is on page seven of the bill under the stars that says employment Um What we do in the civil rights unit by way of background is we Enforce both the fair employment practices act as well as several other employment discrimination related laws We Can we have the ability to investigate private employers? For potential violations of that law In addition to our investigations, we feel complaints and inquiries from the public related to employment discrimination Um, and other workplace discrimination issues So this, um S197 as written would add genetic information to the list of protected categories Under vermont fair employment practices act that would mean that employers could not discriminate against an employee Based on their genetic information As you can see again, if you're at the bottom of page seven The existing list includes things like race color religion National origin sexual orientation gender identity place of birth. So it would add genetic information in there Um While this is not currently in vermont law The federal genome which it sounds like has been discussed here already does include employment discrimination provisions For any employer with 15 or more employees So this would effectively from an employment perspective be bridging the gap for those small employers in vermont Who have less than 15 employees They would also be subject to those non discriminatory. It's just non discrimination provisions um Our office has what's called a work sharing agreement with the federal equal employment opportunity commission So any law in which there's both a federal and a state law that corresponds um Our state office can also investigate on behalf of the EOC effectively and and they can approve our decision so that there's not two concurrent investigations going on So this would then bring a genetic information under the purview of what our office would also Be able to enforce I spoke with folks in our office in my two years with the unit We have not seen any inquiries to our office specifically based on employment discrimination based on genetic information Julio toms and our director who has been in his role for about 10 years Has not uh, is not aware of a specific genetic information complaint either That being said because we didn't have that enforcement We sometimes would look at these things through the lens of disability law because a lot of times there might be overlap between um, what might be considered genetic information and someone with it A disability or a perception of a disability which is currently within our enforcement authority Um, and I guess I would add backtracking the definition here Seems to effectively be the same definition as in genome when it comes to employment discrimination So there's not a lot of difference there. So it would truly be be backfilling there um So given all of that we are generally in support despite the lack of complaints We've received specifically genetic information. We are generally in support of adding that to the employment discrimination provisions, um, you know, it would allow our work sharing agreement at the EOC to include um genetic information something we would normally if someone truly had a genetic information complaint That did not fall under disability discrimination. We would have to send them to the federal EOC For that investigation. We couldn't do it. So in addition it would cover that Um, zero to 15 employee employer Um, employees of that business would also have those protections of the law Okay, thank you. This is very helpful. Great. Good. All right. Any questions? So I'm sorry you're referring to page seven. Are you referring to the peer employment practices? Yes, it acts itself. Okay, correct 21495 Okay Great. Thank you. Good luck Eliza. Thank you. Thank you for your attention. Thank you for your work And you know listen, it would be extremely helpful if we could get what you've had Your testimony electronically, is it possible between uh, I don't have to share your hand confirm that. That'd be great Excellent. Good. Thank you. Thank you. All right Falco Good morning So my name is Falco Schilling. I'm the advocacy director for the ACLU of vermont This is my first time getting to come in front of this committee in that role But I've had the pleasure to work with many of you in other capacities before So just very briefly want to thank you for the opportunity to testify today and say that the ACLU of vermont Supports s197 Individuals as you have heard might want to get their genetic information for a lot of different reasons Many of them having to do with the ability to address medical issues And that but there's also a fear of how that information will be used and and We think that that fear in itself could have a chilling effect On folks trying to get that testing trying to get that information proactively They could have a really positive impact on their lives and so just very briefly We support this legislation and think it would be a positive step forward for the state Thank you Questions. All right That was simple. Yeah Very much. All right Thank you all. No, this is um This is all really good information and where it's now been put into our individual brains Uh, we will come back to this bill this week So we can make a decision about how to go forward And so that will probably be um This today wednesday. Yeah, it'll be a thursday or friday, so I can't I can't say any more than that at this point but if what I would ask the committee to do is to Go through the testimony that we've heard And then to go through the bill again and think about questions that we might have for damien so we can Make any proposals of amendment that make sense I do know that there are three other states that have passed similar legislation for life and disability. Um, so I'll try and get that information To everybody as well Okay, thank you all We're going to now clear the room And thank you, uh, dr. Wood. Are you still there? I am. Thank you. We're going to say goodbye. Thank you for being here. Thank you all So Katie, thank you for being here. We have a new or at least a proposal For this bill 295 And you want to show us what we've got There's a amendment draft 1.1 and the new language is highlighted So I should say Katie McDonough was the legislative council for the record So we're looking at 295, which is the PFAS bill and where the changes are in section two Which is the section pertaining to the food packaging specifically um in the Thank you page six. Um in the bill is introduced. There's language that prohibits Um, so the person shall not manufacture sell offer for sale distribute for sale or distribute for use in this state A food package to which PFAS have been intentionally added in any amount Um, so that's language in the bill is introduced and then the proposed change Is highlighted in yellow. So this is new language that wasn't in the bill is introduced The language you just read would be struck through and instead there would be a directive for Rulemaking and actually I should back up It's not so much of a directive because the language is may adopt rules instead of shall adopt rules If you see at the top of page seven the department of health may adopt rules So I'm inhibiting a manufacturer supplier or distributor from selling or offering for sale or for promotional distribution of food package or the packaging component of a food package To which PFAS have been intentionally added in any amount greater than an incidental presence So i'm going to pause here again. And this is something I Noted yesterday that um the phrase intentionally added in any amount greater than an incidental Presence this language just differs a little bit from the language you have in the bill with regard to firefighting foam and carpets which just which just says intentionally added and there's um language here and any Greater amount than incidental presence So there's a policy decision for you there and I just wanted to flag that it's treated differently in two different areas This section goes on to say that the department may only prohibit the manufacturer Supplier or distributor from selling or offering for sale or for promotional distribution of food package Or the packaging component of a food package in accordance with a that we just went over If the department determines that a safer alternative is readily available in sufficient quantity And at a comparable cost and the safer alternative performs as well or better than PFAS in a specific application of PFAS to a food package or packaging component of a food package And then next in subdivision two The department if the department does adopt one of these rules That would prohibit the selling offering for sale or promotional distribution The prohibition could not take effect until two years after the department of terms that is safe Determines that a safer alternative to PFAS Product is available. So to summarize the bill is introduced has kind of a straight prohibition and this Is kind of backs off of that and says that the department may adopt rules to prohibit certain food packaging items But if they do so there have to be Safer alternatives at a comparable cost that perform as well And if the department finds that and determines that they're going to do a prohibition It can't take place till two years after their determination was first made And the two-year period is consistent with what we've done on children's products So this this language comes from Made and so it's not it's not written in stone yet, but I think it's important for us to consider There are a number of folks who have been talking about the lack of containers for certain products We don't want to open up pandora's box on the other hand and allow for PFAS to be used everywhere all the time because it's not Would not be a healthy situation, but we do want to be considered of what's happening out there in the real world Do we so will we hear about examples of? I'm we've got testimony coming out. So I wanted us to be aware of this before the testimony Thank you And by the way, I did send this out the kb sent it out to the department felt so we need to hear what their thoughts are They may want to change it from may to shall They may not can I assume you took testimony on this while I was gone We're taking testimony on it, right? Yeah, because it's changed This is changed. Yes. This is from me. Yeah. Yes, right Based on some concerns that we had heard. Yes. Okay So we have folks on the telephone and Dory's going to ring them up for us In order Eileen Well, they're all on together. They're all on together. Yes, they're all one phone over They're all in one place just to make it up over American chemical console. Yeah We got three and I think they're going to have different things to talk about Fine. This is good. And then there's another person who was expecting to follow all our work like this And then we would have six foot Well, then there's yes some stuff happening with that. So Any valid encounter? Oh, this is senator lions with the senate health and welfare committee of Vermont welcome Uh, thank you. And I'm I'm thinking we're talking with Eileen cock. Canealy Laura brust and renee lani. Is that right? That's correct. Terrific. Um, you are With us around the table are senators Cummings senator westman senator ingram Senator McCormick and then interested folks in the room We are taking testimony on s295 and we will open it up for you to provide that testimony Hey, thank you. Good morning. My name is Laura brust I am assistant general council of the american chemistry council and I am Constituting today on behalf of abc's polycarbonate bpa global group in opposition to go to restrictions and s295 Related to the use of 15 mils of food packaging This final a is also known as bpa is used primarily in the manufacture of polycarbonate plastic and epoxy resin Polycarbonate plastic is a shatter resistant lightweight high performance plastic with toughness optical clarity high heat resistance and excellent electrical resistance Common uses of polycarbonate plastic include protective and corrective eyewear Fort safety equipment automobiles Compact discs and eds medical devices Food and storage containers and electronic equipment Epoxy resins are used to coat metal cans and containers to prevent corrosion Especially when intended for acidic boots These linings create a protective barrier essential to public health to prevent prevent canned food From becoming spoiled or contaminated with bacteria or rust Epoxy resins have many other uses and can be found in cars boats and planes and as components do fiber optic and electrical circuit boards While bpa is used to make polycarbonate plastics and epoxy resins It is consumed when the plastic or resin is manufactured and only trace residual levels are present in the finished material bpa is not intentionally added to food packages and at most would only be incidentally present as a trace level impurity Polycarbonate plastic and epoxy resins have been approved for decades by the u.s. student drive administration The european through safety authority and numerous other government agencies worldwide for use in food contact applications Attached to my written testimony is a fact sheet providing additional information on these government reviews of bpa safety In february 2018 the u.s. National Taxicology program Releases the result of the clarity core study the largest study ever done in bpa And conducted by scientists as a student drive administration Clarity is a multi-pronged u.s. federal government research program designed to assess the potential health effects of long-term exposure to bpa The clarity core study expanded on an earlier fba conducted study that found no health effects from bpa and typical consumer exposure levels This prior study assessed the potential for bpa exposure to cause health effects and the offspring of rats In the room and through the early developmental stages of life after birth The clarity core study further assessed the potential for bpa to cause health effects over a longer period of time Rats began exposure to bpa while in the room and exposure to bpa continued over their entire lifetime after birth The clarity core studies principal investigator has stated that quote bpa did not elicit clear biologically plausible adverse effects at levels remotely close to typical consumer exposure levels In a statement released in conjunction with the study's draft report Dr. Steven Ostrop deputy commissioner of free foods and veterinary medicine at sda said quote our initial reviews support their Determination that currently authorized uses of bpa continue to be stated for consumers The clarity program built upon the work of earlier u.s. federal government studies That collectively provide a clear understanding of potential for bpa to cause health effects In recent years more than 20 significant studies by u.s. government researchers have been published in the peer-reviewed scientific literature The findings from these preceding studies tell us the consumer exposure to bpa is extremely low And that bpa is rapidly rapidly eliminated from the body Based on these results. It can be predicted that bpa is unlikely to cause health effects The results of the clarity core study Confirm there is no risk of health effects from bpa at typical human exposure levels Even if people aren't supposed to bpa throughout their lives attached to my written testimony is a fact she providing additional information on the clarity core study Based on the foregoing we opposed the proposed restrictions in s295 related to use the 15-odd intensive packaging. Thank you for your time So do we have your testimony? We don't have our we have to refresh Just hold on a minute. Thank you Okay Is it under renais name? Okay, we don't have your testimony for some reason It's under renais and we have renais name on it. So that's what I did. Sorry. I was answering other emails at the time I didn't do that. Oh, here we have it. Okay. Good. We've got it. Yeah. Thank you. Thank you. All right. Sorry for the confusion for a minute So you're testifying basically on The the bill Section page eight for us seven and eight Lines 18 through 20 on seven and then lines one and two on eight in concerns about Miss fennels That have been intentionally added in any amount greater than an incidental presence That's correct. Right. Okay, and so Any food package questions Is the difference it may have been added but then during the process It becomes an incidental presence. I think that's the testimony I heard. Can you clarify that please? Did you hear the question? I did. So bpa is used in the manufacture of polycarbonate and epoxy resin But it's not intentionally added to those products themselves So during the course of the manufacture the bpa would be consumed in in the process and wouldn't be Intentionally added to the end product itself. It would only be available at most different trade amounts So The difference between what you're saying and what the bill says is what? I think what the bill is saying Is that you know these phenols are added to food packaging At you know for for a purpose in the package itself and that at least for the case of the phenol a is is not the case It is not It is only used as a as a component of the manufacturing I guess it would be great to have a picture of this. Okay. Are we talking top or where are we talking? Because when you say added to I see a coating on the inside Of the tomato of the tomato can Right What I think the difference is we're saying is it is intentionally added to The start of the process But by the time they come To the final consumer product There's only a trace amount left Is that what you're saying? Yeah And so that would be incidental Correct. And this is an SDA approved food contact use and since the clarified polycarbonate would not be used in Tupperware Polycarbonate is a hard, clear plastic Okay Any other questions? What How would you change the language so that we don't capture? It sounds like we're not capturing what you're talking about So we'll have to clear it make sure that we understand that I would propose Removing dismaying all from this from the bill all together Fix a lot. Okay Thank you. All right.  So all right. We're we're we're working Together and differently, but our goal here is to ensure some basic public health protections so We do appreciate your testimony and we understand that We do understand that some of these chemicals are critically important for our plastic Industry and the same time in the work that we've done previously. We understand that's persistence in the environment and its Its effect, especially at developmental stages Yes, I'm just looking at the definition of intentionally added. Yes And that says the addition of a chemical in a product that serves an intended function in the product's component there's I think what we've got is there's adding it at the beginning when you start mixing all this stuff up You heat it it burns off and by or whatever and by the time you get to the end There's only trace elements in the end product Of opposed to some of the things like my dental floss And which it is an outside coating Right or the coating in your tomato can Well, last time we did that we got stuff about it was preventing Fossilism, right, which is also and it hasn't that hasn't changed that piece. No, it hasn't and I don't know that I want a fan You don't want to be in botulism. I want yeah, so I want immediately Senator, I hear what you're saying that what I'd like to do is to See if there are any other questions for for Laura or Eileen or Renee who are also on the phone Any other questions because we'll see if we'll come back to this And Eileen and Renee have additional comments to make Please do So I'll start if that's okay. Yes, please go ahead So good morning. My name is Eileen Kanely and I'm also from the American Chemistry Council And I'm testifying on behalf of the American Chemistry Council high values panel The proposed legislation seeks to impose restrictions on the manufacturer's sale and distribution of food packaging To which phthalates have been intentionally added in any amount greater than an incidental presence The legislation seeks to prohibit all ortho phthalates from use in food packaging Including phthalates such as diisonomol and diisodecl, which we call the imp and divp And these phthalates are currently permitted for use in food packaging in the us and across the globe And there's overwhelming evidence of the safety when used in components of food packaging The term phthalates represents a large family of chemicals that happen to be structurally similar But which are functionally and toxicologically different While all ortho phthalates assure that same functional groups the carbon chain lengths of the alcohols are significantly different And this is very important to understand their safe use Phthalates can be categorized as high and low depending on their molecular weight The low molecular weight phthalates have three to six carbon atoms in their backbone And the high molecular weight phthalates such as dinp and divp have seven or more carbon atoms in their backbone Because of concerns in animal studies some of the low molecular weight phthalates have been classified As likely to cause adverse effects to reproduction in the european union However, dinp and divp, which are high molecular weight phthalates Have undergone rigorous regulatory review in the eu and around the world And they are not classified for any human health or environmental hazards And are considered safe for use without restriction dinp and divp have been evaluated for potential reproductive and developmental toxicity for over 20 years Most recently in march of 2018 after a three-year review the european chemical agency concluded That no classification for dinp for either effects on sexual function or fertility or developmental toxic warranted Similarly the u.s consumer product safety commission completed a thorough hazard assessment On the potential of divp to impact reproductive fertility And found that there was no concern with exposure to children pregnant women or any susceptible individuals As a result the idp in children's toys and child care articles is no longer restricted in the u.s There's no evidence for any other alleged adverse effect with dinp or divp And this is evidenced by the lack of classification for any end point With regard specifically to food contact uses the u.s FDA is currently reviewing a petition to revoke Existing u.s food contact clearances for 30 ortho phthalates And they're reviewing a food additive petition from the flexible vinyl industry Requesting that FDA amend the food additive regulations to no longer provide for the use of 26 ortho phthalates Because those uses have been abandoned A u.s FDA report on the use of plasticizers In pvc food packaging concluded that the use of ortho phthalates and food packaging in the u.s is low As most manufacturers have switched the use of alternative plasticizers So we would urge the committee to delay any action on senate 295 pertaining the phthalates until the u.s FDA has completed its evaluation on these pending petitions Dinp and divp as I noted have been subject to rigorous evaluations of potential risk in dietary exposure By regulatory agencies around the world for the last eight years Without exception every evaluation has arrived at the same conclusion that there's no health concern for divp and divp in the diet Just to give an example and all of these are detailed in my written testimony In december of 2019 the european food safety authority issued an updated risk assessment on five phthalates Including dinp and divp Finding current exposure to these five phthalates and food is not a concern for public health There were similar conclusions by the food safety authority of ireland the uk food standards agency the european chemicals agency The new zealand government and ministry and primary industries each of these finds that either Phthalates in packaged food is not a food safety concern or there's no health concern And current dietary exposures included Are not considered to be a health concern Thus these risk evaluations provide overwhelming support for conclusion that phthalates particularly dinp and divp Are not a human health concern of dietary exposure around the world And i would note that in contrast to this proposed bill in brahman in japan It was recently announced that dinp and divp were actually placed on their first draft of Materials in our percentage for use in food contact materials and that was in august of last year Thus our position is that with respect to phthalates this bill does not provide any additional health benefit to the citizens of brahman Contrary to what some have said in testimony in front of this body The u.s. Is not an outlier with respect to permitting use of dinp and divp in food contact applications They're permitted in europe in the murkasser countries of argentina brazil haraway in iraway permitted in japan new zealand australia south korea and several other places around the world Finally it's important to note that the testimony in the record from april 17th of 2020 from dr. Marisol Maffini Contains numerous inaccuracies and misrepresentations concerning phthalates I detailed these in my written comments, but i'd like to highlight a few for you this morning On page three she has stated That all of the phthalates that were approved by fda were approved before 1985 And although the scientific knowledge has advanced there hasn't been a reevaluation of their safety since 1985 These statements are misleading and incorrect Most of these 28 phthalates have been phased out only four remain in food contact application today Excuse me As i noted fda is currently reviewing a petition On phthalates in food contact and many of these uses have long since been abandoned As part of its review fda recently released a report on its investigation of the use of plasticizers and pvc concluding that the use of ortho phthalates in food packaging in the united states is quite low Additionally as i just noted there have been numerous reevaluations of the safety of phthalates in food packaging By regulatory agencies across the globe in the last 10 years including in the uk The eu new zealand australia in canada None of these has found a public health concern and most continue to permit the use of phthalates in food packaging Uh, additionally the testimony from dr. Masini stated on page three That fda doesn't have limits to how many phthalates how much phthalates can be present in food And because they're not tightly bound they migrate easily This statement wrongly implies there's no regulatory oversight on how phthalates are used in food packaging This is not true. For example fda has specifications for how dindp can be used in food packaging And restricts the use at levels of no more than 43 percent in food contact pvc And only when used with non fatty and low alcohol foods It's almost identical to the specification in the u With respect to the ability of phthalates to migrate into foods. We would note that that's not specific to phthalates All plasticizers theoretically are able to migrate to food However, phthalates like dindp and dindp are tightly bound to the pvc and do not migrate easily Furthermore on page four the doctor notes that academic studies have linked these chemicals to various reproductive developmental and endocrine health problems These statements are incorrect as noted previously dindp is not considered to be a reproductive Toxicon in the eu australia or canada the uscpsc also confirmed in 2017 that dindp is not Is not anti-androgenic and is a negligible concern for children pregnant mothers and other susceptible populations Furthermore on page four of her testimony The doctor noted that cpsc had advised to permanently ban eight phthalates due to an increased health risk in children This is incorrect. Although cpsc made permanent a ban on dindp in toys and child care articles They removed the ban on dindp and dindp in toys and child care articles As it found as i noted they pose no risk to children pregnant women or other susceptible individuals Um, I would also note that um, dr. McPhaid Noted that the european chemical to agency evaluated The cumulative risk of phthalates so on and so forth and she noted that they estimated a tolerable daily intake for what she did not Note in her testimony was the result of those evaluations Were echo found that there was no risk Expected from combined exposure to dindp and dindp for children exposed to be a food and the indoor environment EFSA, which is the european food safety agency Public safety assessment just this past december Concluding the current exposure to these five phthalates from food is not a concern I would also note that um, she has noted that fda has not taken any measures to deal with phthalates and food We counter the statement as misleading and it suggests that other food safety regulatory agencies have restricted the use of phthalates and food packaging And that us fda somehow is an outlier in not taking measures In fact, as i've noted all major food safety regulatory agencies around the world continue to maintain the use of phthalates and food packaging Save for all current uses Finally, I would note that dr. McPhaid notes on page five that Petitioned from the public interest groups to fda demonstrated when the cumulative effect of chemicals in the diet are considered is acquired by law That fda cannot conclude the use of the food contact is safe Uh, I maintain that this statement is counter to the conclusions in the more than five risk assessments Conducted by independent food safety agencies around the world Including EFSA health canada food safety australian new zealand and new zealand mpi The uk and ireland food safety authority Each of those finding no appreciable public health risk low exposure Etc with the use of high molecular weight phthalates include packaging In conclusion, we recognize some support the efforts of the vermont legislature and protecting the consumer However, it's important that this effort is based on information that's accurate and provides tangible health benefits to the consumer There's overwhelming evidence that high molecular weight phthalates like dinp and divp in particular Have improved states and food contact applications all over the world In this regard, we urge the committee to exclude the blanket prohibition on phthalates in the current legislation And what we would suggest uh on page seven of proposed bill Is that if you're going to move forward with uh a ban that you would add language saying the prohibition will not apply to any uses of Phthalates and food contact material authorized by the u.s. Food and Drug Administration I thank you so much for your attention Well, thank you. Thank you for your testimony. Um We frequently do get um Battling testimony in here one side against the other and you brought it to a new level But we thank you for your due diligence in uh going through the Work that we've already heard about And we will continue to take testimony Seriously do appreciate the work that you've done on this and But also understanding Naturally that you do represent a specific interest group and so we need to keep that in mind so but we do appreciate what you've done and the The work especially in the eu is uh is important to all of us. I think because of the We in this country use grass or generally regarded as safe and the eu Um Does it more of a precautionary process? So Perhaps we should move toward the eu all together. I don't know would that be something that the american chemical council would support? We support science-based decision-making and you'll see in my written testimony that i've referenced the many extensive risk evaluations done by regulatory agencies including in the eu okay, so um Do we have the testimony that you just provided because I don't see it on my page Well, we'll refresh it one more time Questions So your concern is about a specific class of the um The high molecular weight chemicals Correct. I you know a cc's uh stands which I believe my colleagues would agree is that each chemical needs to be evaluated on its own And if you look at the regulatory agencies around the world that have evaluated sallies and food contact material They've always looked at each chemistry on its own merits And all the you know 30 years of scientific testing on sallies to come to their conclusions And that is why they still authorize for use in the u.s In the u and in many other countries Okay, thank you. Well, thank you. I'm sure we're going to hear testimony further testimony. We're going to have to put this together and balance Our decision between what you presented and what we continue to hear what we and uh, thank you appreciate it very much Others In the around the table I want to ask a question Is there any more testimony that you have I don't why leave anyone out Yes, this is renai laning. We have one more test this morning, so The committee is ready. I can begin Okay Are you providing it? Yes, yes, so good morning members of the committee. My name is renai laney and I'm also here on behalf of acc The chemical industry supports a comprehensive approach to managing per and polyfluor alcohol substances or pfas Which are at issue in this bill and that helps to protect And ensure the protection of human health and the environment This includes appropriate science-based policies and regulations As 295 as drafted seeks to regulate or ban several different types of products containing pfas Uh for the reasons I'll outline we oppose as 295 Fasks used in today's products are important to modern life and are a key enabling technology The strong fluorine carbon bond allows pfas to provide products with strength durability stability and resilience These properties are critical to the reliable and safe functioning of a broad range of products that are important for industry and consumer pfas play a vital role in everything from lower-air missions and improving safety reliability and fuel efficiency in automobile To manufacturing semiconductors solar panels and high performance electronics Many other industries also depend on high performance pfas including aerospace alternative energies house care building and construction chemicals and pharmaceuticals oil and gas Just the name of here Regulation or legislation should not group all pfas together or take a one-size-fits-all regulatory approach pfas are a diverse family of chemistries that includes a broad range of substances with different physical chemical and toxicological properties and uses Hence the hazards and risk profiles various pfas chemistries are very different It is the it is neither scientifically accurate nor appropriate to group all pfas together Or take a one-size-fits-all regulatory approach to this wide range of substances This will deter innovation undermine effective product design and may even lead to the elimination of an entire chemistry that is enabling technology for a broad array of vital products It is important to recognize that most of the attention to date on pfas has been focused on a handful of substances that are no longer produced in the US, Europe, or Japan Additionally significant regulations Including the lattenberg chemical safety act are already in place for new and existing chemicals and specific actions have already been taken to help manage pfas This includes the us epa comprehensive national pfas action plan as well as other actions initiated by various agencies In addition, manufacturers and many users of pfas are implementing a variety of practices and technologies to help minimize environmental emissions These ongoing actions should be factored into any additional efforts to assess and regulate this broad class of chemistries The scientific and safety data on specific pfas substances should also be used to guide public policy effective chemical regulation Regardless of the substance includes consideration of a chemical hazard characteristic Its use an actual level of exposure to assess the potential risk of a particular chemical and determine the most appropriate risk management measures These fundamental principles have unfortunately been lost in the current debate about pfas chemistry Taking an overly broad and non-scientific approach to pfas will make it difficult to implement effective regulatory policies It will also impact an extensive source of the economy Including a broad range of industries businesses public entities like airports hospitals drinking water facilities and municipalities For these reasons different pfas requires different regulatory approaches Furthermore state actions should be conducted within or consistent with appropriate regulatory frameworks Vermont has designed a robust regulatory system and established policies for managing chemicals within the state including pfas These frameworks ensure consistent science-based regulatory approaches And provide transparency broad stakeholder input and enforceable regulations We support establishing clear timelines to ensure that policy decisions and regulatory outcomes are completed and implemented in a timely fashion But by bypassing or ignoring established regulatory authorities and predetermining regulatory outcomes undermines the regulatory process And it establishes a dangerous precedent for addressing other chemical issues in the future And prevents policymakers from focusing or pressing issues of public concern In my written testimony, which you hopefully should have i've also provided additional reasoning for each of the sections Outlined as a bill I'm going to provide a very quick high level for each of those Right now, but i'd be happy to answer any further questions For the portion regarding aqueous film forming foams a triple offer of the fire fighting foams with potentially pfas We are concerned with the way that portion of the bill is drafted I think we've seen legislation counts in other states that take the more appropriate Approach, which is putting requirements for best practices on the end users to help minimize emissions by ensuring that fire fighters As well as those who have high risk of class B flammable liquid fires have the appropriate tools available to them in emergency situations While also preventing evictions to the environment in non-emergency situations For food packaging and I think this goes to the discussion before fda has a significant regulatory process in place For instance, the pfas chemistry Do not go through the grant process as you noted earlier. They go through the food contact notification process. So Not all food contact chemistry goes through the generally regarding the safe process in fda And i was outlined in my comments the robust process that fda uses To determine whether or not something to be used in food contact as far as Carpets and grub No other state has passed such a piece of legislation that would Outright ban an entire group of chemistry indiscriminately from a product sector Any state to have looked at this has gone through a regulatory process and we would encourage Vermont to do the same And then finally the council's of high concerns of children the addition of the entire class of pfas to the this list Again, no other state has passed such broad legislation Because pfas chemistry there are a family of Different chemistries with different properties many chemistries that are classified as pfas would actually not Qualified for the regulatory processes outlined and the criteria That vermont has the legislature has detailed for the addition of new chemistry to that list If the state is interested in pursuing addition of certain pfas chemistry to that list We would encourage them using the regulatory process that the legislature Has helped enable to be put into place So in conclusion for all of the reasons of stated and everything provided in my testimony to the committee We would ask you to oppose f295 and be happy to answer any questions the committee may ask Okay, thank you questions So as i'm looking at some of the comments that you have With regard to the fda in particular and its regulatory scrutiny over intended use And then level of toxicity What type of clinical studies go on? That would suggest a clean battle health for example or not You know every chemistry is going to be different So I can kind of talk a little bit specifically about the pfas chemistry that has gone through fda has you know I'm not I'm not a company in this happening on a company by company basis But fda has the ability to request as much information as they want before these chemistries are introduced to the market Basically fda needs to be comfortable with allowing that chemical to be introduced to the market I know some of the studies that have been provided by my companies to fda include cancer as a reproductive health assessment General toxicity studies. So it really covers the floors of information that fda may look to and they're also allowed to continue asking for additional information as You know an fda requires to continue to remain on market That being said you know fda has Exercise its ability to remove chemistries from market historically and there's only certain pfas chemistries that are on use It's a pretty small number of pfas that are actually approved for use in different to compact applications Okay, thank you other questions. Thank you. We're good. Thank you. Thank you all as is there more testimony No, that's what we have that's good. You have a lot We appreciate it and if you have distinguished a couple things for us when we do appreciate that so We are Moving on to our next person. So we are going to say goodbye to you And thank you again Thank you. Thank you. All right. Good. It's also a phone call. Okay, and do we have his Whatever has been sent to me. Okay, so it's stewart home and I don't the chief scientist of the american forest of paper association Uh, good morning stewart. This is senator lions Vermont health senate health and welfare committee Hi, how are you? I'm doing quite well. Thank you very much. All right.  Yes, no, no, okay. Not yet. Not yet. Okay. Well if we'll listen to your testimony and then if you could provide it to us electronically That would be very helpful Absolutely, chairwoman. All right. Thank you. Thank you very much Go right ahead introduce yourself Go ahead Good morning, madam chair by chair westman and members of the health and welfare committee My name is stewart holman. I'm the chief scientist for the american forest and paper association I appreciate the opportunity to share our concerns with legislation under consideration by your committee and act related to restrictions on per floral appeal and Poly floral appeal substances and other chemicals of concern consumer products In vermont the industry employees more than 4,500 individuals with an annual payroll of nearly 151 million And its state local taxes paid by the forest products industry totals 14 million dollars annually I'd like to focus on section two Where this bill seeks to ban food packaging that contains any amount or type of intentionally added PFAS for this phenol AF and PA members are committed to ensuring the safety of their products including the safety of chemicals Using their manufacturing processes AF and PA believes the chemical and product related legislation and regulations should be protective of health Cost effective and based on the best available science We support continued research on the safety of PFAS and this phenols in our products We believe the state should avoid duplicative regulatory efforts Chemicals and products and manufacturing byproducts should be regulated as a federal and not the state level It is essential that products moving in interstate commerce be subject to uniform standards That bill 295 ban food packaging that contains this phenols in any amount greater than an incidental presence Let's talk about the most commonly discussed this phenol. That is BPA The majority of BPA exposure is from food the food and drug administration or the FDA Their current perspective based on its most recent safety assessment is that BPA is safe at the current levels occurring in foods To date no states have directly linked exposure to BPA with cancer in humans and animal studies support this various scientific groups including the us national toxicology program or NTP And the european union therefore concluded that BPA is not a carcinogen Putting to PFAS has written f 295 also bad as the intentional use of any type of PFAS and food packaging The FDA has stated that it has quote unquote carefully reviewed the available science on the short chain PFAS compounds And has not identified any safety concerns Additionally, the FDA is careful study and approval of the use of short chain PFAS chemicals based on the best available science allows for continued production of safe and reliable food packaging On this basis, we believe FDA regulated food packaging utilizing PFAS chemistry should be exempt from additional legislation or regulations Of the thousands of PFAS chemicals that exist and I've heard it's been up to five thousand There is a short list of compounds less than 20 that the FDA specifically reviewed and approved for food packaging applications Based on thorough testing and risk-based assessments However, as f 295 is currently written FDA approved PFAS and food packaging would also be bad We recommend that f 295 be amended to fix this oversight So in conclusion the committee should realize the unintended consequences of enacting this bill Specifically the bill would have a significant impact on the vermont's economy and population as it would penalize the sale Of many food packaging items sold in the state We encourage the committee to avoid measures that might penalize paper products We look forward to continuing our work with the state of vermont and i'm happy to answer any questions Thank you Thank you very much Questions from the committee Yes One of the comments that you made was that At least one of the Chemicals of concern that we're looking at doesn't cause cancer. I think it was bpa But yes, but you also understand that there are other neurodevelopmental or Concerns that are associated with that chemical as well as others. So it isn't you know Yeah, the f da in their 2014 review of over greater than 300 scientific studies I think it'd be very useful for the committee to review What f da is I think you'll come up with a different conclusion in terms of human exposure to ppa Thank you. I think many of us have already reviewed that but we'll go back again And I do appreciate your comments and your insight into Um an industry that we have in the state and how it might be affected Very much. I appreciate it. All right Thank you. Any other questions? All right We'll say goodbye and thank you very much and um wish you well Thank you very much. We'll be both all though. Take care Red button, senator I got that in time. Good work Got back just in the middle of time Okay. Well, that's a lot of information. I think we have a couple other folks who we may be hearing from tomorrow What we wanted if we're going to do something on this bill we do it by by friday So go through and think about what's been said. I know there's a lot of chemistry in here That is He's above my paint great. Right. Have we And I I gather you you must have taken testimony while I was in new york, but have we heard from the firefighting equipment? and is it available We did hear from the firefighters association. No equipment. We haven't heard from the equipment people I think that might we'll try and get some I don't want to tell them They can't use what they've got and then find out It's going to cost my volunteer fire department $100,000 or a million to replace We'll do what we can do. Yeah If you have any suggestions No, okay I find out they can make We'll find out on the firefighters. We'll find out, but I think they have the power to make rules Who? The health department they do we don't have to give it to them. They're coming back to us with their comments So that we set this out to them. It's the firefighting Equipment. I know the union. Yes would yes Definitely like us to tell the town that they have to buy all new equipment We might want to hear from the lead great We haven't heard from them. Yeah, but we will yeah. Okay. Good. We'll do that All right anybody else The equipment people Anybody else all right We'll come back to this The section that is in yellow in the bill. Think about that section. I think it does Support some of the testimony that we heard Okay, and the other you know the the other thing is when people start talking about it Doesn't cause cancer and remember that there are other things out there besides cancer. Yes. That's that's that always becomes the topic of conversation It could be a neurodevelopmental something or Some other But it is above mine and that's why I'd like to leave it to the department of health Right exactly, but the other thing is that with all the work that we've been through on some of this We've heard a lot of testimony on these chemicals over time So and I'll leave it to you and your daughter doesn't do this one out Okay, so we'll leave this bill and we've because we're going to move on and we have a couple other things we've done to stem cells No, we're going back. We're not going back to stem cells right now It doesn't sound like we're sitting right. I've got we have to get Jen downstairs to talk about one bill Katie is here. So we're going to use her expertise While she's here on 2 18 and 185 Yeah, if you need to take a break, this is a time So we're back on the record And we're on s 185 and we have pristine Vadovac who's a lecturer at the Rubenstein school To comment on s 185 Gonna make some general comments So we'll start with that one and then we'll go to Because we have a new And she does that testimony Good morning, uh christine. This is senator lions in the vermont senate health and welfare committee. How are you? Hi senator lions. I can just nearly hear you. I have a little bit of Got it briefing you up right now. Oh, okay. Well, can you hear me now? Yes. Thank you. All right. Um, I'm gonna shout We're sitting here with senator Cummings senator westman senator ingram and senator McCormick And interested parties in the room on s 185 And we have your testimony. So we would ask you to introduce yourself for the record And provide your testimony for us. Thank you. Sure. Well, thank you for inviting me My name is pristine vatovic I teach two courses as you receive them up that are directly related to s 185 The first course is human health in the environment and second climate change to human health And I conducted research related to climate and health as a fellow at museum gun in super environment And I'm also an adjunct research assistant professor at medium larner's college of medicine And my testimony is that Climate change has been described as the biggest public health emergency of our time because of the several risks that poses to human health The intergovernmental panel on climate change or i t cc the world health organizations us centers for disease control and prevention and our own vermont department's health in turn to provide the overviews and analysis Of the specific climate related health threats posed globally nationally and locally At the same time Pre-eminent climate and health scholars have various to be argued that addressing climate change provides more of the greatest public health Opportunities of our time Many of the actions that can be taken to mitigate climate change are expected to have positive health and economic benefits Thereby offering women strategies For example, increasing active transportation such as walking and biking will reduce air pollution and greenhouse gas emissions Will improve the health by reducing the risk of cardiovascular disease Diabetes and cancer and will provide cost savings both from avoided emergency room visits and hospitalizations As well as lost worker product tubes that are associated with these diseases For example, the cost of diabetes treatment alone is estimated at 327 billion dollars every year in the u.s The cdc has identified a primary impact of climate change on human health in the united states I provided those the list of those below in the written testimony From that list from the cdc the vermont department's health climate and health program has identified seven key impacts of climate change on the health of vermont These include mental health The impact of climate change can affect mental health in several ways ranging from ptsd Associated with extreme events such as flooding to anxiety related to the fear of uncertainty about how climate change will impact everyday life in the future In a recent study led by my own post postdoctoral research fellow at uvm christine karmichael 92 of vermonters who were interviewed reported being concerned about climate related mental health impact This made mental health the number one climate related health concern among vermonters in our study Vector-borne diseases is the second area Take born diseases such as live disease and anaphylzosis and with keto-borne diseases such as west nile Virus and cdc climate settlatives are both expected to increase and prevalent in vermont Since the warmer climate increases the survival of both those vectors the ticks and mosquitoes And the pathogens that they carry In addition we expect to see the ranges of different tick species such as the lomestar tick They carry different pathogens move into vermont as the climate continues to warm The third area is water and food born diseases Heavy rainfall events which are expected to increase in frequency and severity with climate change Can lead to contaminants and infectious diseases entering agricultural fields private wells and drinking water systems Hot weather is the fourth area in vermont We observe a significant increase in emergency department visits when the ambient air temperature rise is above 87 degrees Fahrenheit The number of days above 87 degrees is expected to double by 2050 The third area is the antibacteria warmer lake temperatures combined with increased heavy rainfall events are expected to increase severity and duration of blue green algae blues Health effects of exposure to these antibacteria can range from skiing irritation to diarrhea, vomiting, and liver cancer Extreme storm events The direct health effects of heavy rain events can range from injuries in the short term To illness related to mold growth or contaminated food and water in the long term And finally air pollution and pollen Rising global temperatures are associated with increases in air pollutants such as ground level ozone wildfire smoke and pollen that cause allergies These pollutants can harm respiratory health Particularly among osomodors and asthma which according to the remont department of health currently includes 57,000 adults and 9,600 children In conclusion, each of these climate-related health impacts will benefit from a coordinated response across all vermont state agencies And as I stated earlier many solutions will have co-benefits that can both minimize the harm caused by phylocene and improve health of vermonters Thank you for allowing me the opportunity to testify regarding osomodors funds I'm happy to answer any questions and I hope my statement opens the door to further dialogues as you move forward through the legislative process Thank you. This is very helpful. I understand that you gave a talk on this subject recently At the college of medicine Right and I one of our the intern one of our interns was there and heard you speak Yes, Abby. That's what Abby said. Thanks. Good Right. She's thrilled as we are. That's very good. She's very good. Yes, so um overall the Having a sort of a general Bill as s 185 is to help Bring regional Folks together. You think is a is a good idea You know, I think I I personally do think that it's absolutely a good idea. Um, I am I'm wondering where you see the possibility of The work that you are doing sitting within the global warming solutions act Where it could potentially bring together more of the agencies and stakeholders Perhaps making health as efficient as a special opportunity under the broader Perview of global warming solutions act so that we aren't Kind of pulling pieces apart and having different agencies focusing on things that really truly are related to each other for example transportation and health go hand in hand Agriculture and health go hand in hand and I'm curious If there's any possibility for a path forward that would bring more more people to the table So that's a very good question. And I think as the global solutions Warming at climate war That act I call it something as that goes forward Will be in contact with the committee of jurisdiction And hoping that they would also add a linkage with public health What we're looking at in this bill in particular is an opportunity to bring all of those folks together at a regional level So the chipping county area where we have a regional planning commission And we and we have agriculture. We have transportation issues and the planning commission Already does deal with many of those Resilience efforts, but this would this would place Health care and public health response into The work that the regional planning commission does so it's a very it's much more targeted But it's certainly not separate from what you're talking about at a statewide level So once you have once we would have the regional planning commissions across the state Working independently and together because they do work together Then that would Suggest Exactly what you're saying. So we'll we'll work on both of those. I don't I don't think they're mutually exclusive either I think I I absolutely agree with the idea of Whatever recommendations can be made of that date level absolutely Would would benefit from being more directed at the local level knowing that different communities have different threats particularly for example, like flood home communities versus Other communities that are of higher ground or places close to the lake that may be more impacted by Santa bacteria compared to Being more up in the mountains where you might have a greater set from ticks for illnesses So I think that that's absolutely a great direction to take the trying to take a more place stage approach Thank you, right. I I think that helps. I know we the equine and cephalitis is Identified in Addison county and they have the mosquito control program Which might be different from what we're seeing for the tick population control in the northeast kingdom where they're where the moose are populated so Yeah, there's a lot of Why they have encephalitis shots for Horses and Lyme disease shots for dogs and we don't have any for humans There's no encephalitis There may I mean I don't know horses. The horses all had to have shots, but They've never heard of it showing up in humans So my understanding is that um, I'm not certain of the history of the triple e-vaccine for humans I've not been aware of that at all. I know that there has actually been a line of these vaccines for humans um, probably it was close to 20 years ago and It was taken off the market by the pharmaceutical manufacturer Not because of any evidence suggesting that it was problematic, but because There was a group of people in the community Around the country who claims that it was causing them to have Lyme disease. There's absolutely no There's vaccines But it is something to think about that there is the science for the vaccine And is it possible to move into that again, especially now that it would actually become more profitable Choose those pharmaceutical companies at this point knowing that many more people are effective and or looking for ways to prevent Lyme disease primary Incarious carrier ticks into the house. That's right Now I have to check the grandkids, but not the grand puppy. Let me ask you one more question before we move on and that is as you I'm certain you've read s 185 and it's an introduction, but You have listed here seven key impact areas Yeah, would you suggest that we include those in the legislation itself or Not I personally would include those um mainly because that's Seeing some of the public health standpoint Those areas are where we have very firm evidence that these are the impacts we expect to see and we know That you know who are the vulnerable populations for each of these areas and we have some ideas of Some of the target strategies that could be implemented Because that is the way coming down from the uscdc and now filtering to the karmic health those are the particular Areas where we predict to see increases in health concerns So I would include the ones that we know a lot about and I might understand that they're very robust Good, this is helpful and And certainly as you look through those there are parts of the state that are very much affected by each one so It's helpful Thank you any other questions None for me Okay, you don't have any questions and I think that folks around the table are satisfied. We we appreciate your taking the time To be with us this morning. Thank you very much. Absolutely. Absolutely. You feel free to contact me if I can help in any way We will thank you. Thank you. Let's take care. Stay safe out there. Take care. Bye That was good. I was kind of serendipity because when I Had the idea to introduce a bill and I have been keeping in touch with what's going on the federal level, but Nobody was really talking about this locally, but now Starting to become important in terms of resilience. It's awesome Katie What should we go through the bill where it is right now? Do you have a set 2.1? 185, which one? Yeah, one is a 2.1. 2.1. There are some changes from the last time you've seen it all right Okay, kitty mcglenn office of legislative council just before we start does everybody think that her suggestion that we put those seven things And it's a good idea. Yeah, I'll invent them. It's from our own Okay Okay, so the first section Creates a chapter public health response to climate change The first piece of that is the climate change response plan And this draft doesn't have any changes to that section since the last time you've seen it The next section 1712 at the bottom of page 2 is the climate change response communication And there have been changes here if you remember this was linking the health department with communication with regional planning commissions and So the language now reads that the health department in coordination With regional planning commissions regional management provider Sorry, regional emergency management providers and the citizens assistance registry for emergencies. That's the care Project that you heard about last week Shall develop a plan to communicate with both Vermont communities and each other for the purpose of mitigating and responding to Climate change related to public health risks in Vermont. So the change here using the word coordination and then Adding to the groups that are are being consulted and coordinating in that communication plan At the top of page 3. There is language Section 2 a report This is just directing the health department to submit their plan By november 1st of this year that language has not changed since the last time you've seen it and Then we have we move To what had been The concept around s 225 the regional planning commission. So we're kind of transitioning on page 3 And now there's New language. There's a an existing section On the duties of regional planning commissions And there are two duties being added to regional planning commissions the first In subdivision 21 consult with and assist hospitals regarding the development of health needs assessments and other initiatives as needed in accordance With 94 or 5a, which is the public participation and strategic planning. We'll look at that section next And in subdivision 22 consult with and assist the agency of human services department of health for emergency management To incorporate public health and safety concerns related to climate change Into state and local emergency and hazard mitigation response and recovery plans So again, two new duties are proposed for the regional planning commissions And then now we're moving to section four, which was the cross reference and subdivision 21 the public participation and strategic planning in Title 18 And here we have language that each hospital shall have a protocol for meeting meaningful public participation in its strategic planning process For identifying and addressing health care needs that the hospital provides Or could provide in its service area. That's existing law The new language is that regional planning commission shall be available for consultation and assistance Pursuant to the language we just looked at it's just a cross reference. So no matter where you look you see that link cool So page five To reflect the fact that you've brought two bills together And it would be an act relating to adopting a climate change response plan and regional planning commission involvement and And identifying health care related issues or needs From the regional planning commissions. Yes. Yeah, and they're coming in again tomorrow. Okay, because I just I think you were I think I was going to stop. Yeah. Yeah. Just wanted to make sure Yeah, they started this whole thing They contacted me this summer And asked to have some of this language put together So Where would we put all those seven things? Do you think we would put them? Can you read the list again? Do you have it right in front of you? Yeah Yeah Okay, it's things like mental health vector-borne diseases water and foodborne diseases hot weather cyanobacteria extreme storm events air pollution and pollen those are the things that have been validated as Impacts of climate change on the health of our monitors Do you want to add it to the list on page two subdivision two? The response plans to provide actionable strategies specific to both rural and urban communities in the state Including specific strategies that address And then you have a list a through g you could add Your that list that our witness just went over To that particular list Well, maybe we should substitute this list. Okay. Yeah, I you know because this Just integrates a lot of different things when you think about it, you know, if you're saying asthma that might be a transportation Maybe Could we get the apartment to come in and talk about their list? We will Ask them to do that We have geren olmer coming in tomorrow at 11 And chris campany of the wind of regional Coming in at the same time hospitals If we put the list in We'll ask what's the timeline on this this bill? Well, it just hospitals We've got a little amendment on the floor And some of us didn't vote for it in committee, but the argument was this is not the time to ask hospitals to do anything They are up to their eyeballs That's why this was a study and That's a good pointer So let's go back and look at that language where the hospitals are asking them to do this Just adding something to what they already have to do. I think that's fine. Hospitals are currently doing what? They're currently um, they have a they have to have a protocol for meaningful public participation in strategic planning process Yeah, so they can just send a letter or note and say hello regional planning commissions. We're having to hear Yeah, that's that's fine. So I just want to make sure that we are we'll make sure I'll talk with them Yeah, but more Devin on to say it on the record. We've got to Try Is she coming back and say what she said? All right, we'll we'll get her to say it on the record. That's good Okay, thank you for that. So I think this one's moving along nicely. Um, then, um It's an important bill and if it gets incorporated into the that other bill, um So be it I don't know. That's why I'm not keen on integrating it and I thought I had it, but I don't I assume economic development It's a jobs bill The Green New Deal 218 was an age that's an age bill though. Yeah, so it's got a ways to go. Yeah, it's probably also maybe in there So Katie has brought us a new draft of 218 But it is where is where is the information we have to refresh To get commissioner squirrels just to clarify. I'm not bringing you a new draft But I know that I'm familiar with the draft that commissioner squirrel has sent you Okay, and before you begin We're looking at s 185 and we're asking the hospital association to Take a seat and answer the question As you're doing your outreach, would it is it To do your hospital planning process Would it be a cumbersome to add regional planning commission to the list that you communicate with? um, I Believe the regional planning commission shared some language with you that we felt comfortable with so Um What we were hoping is that the we find the regional planning commission useful We have some really good partnerships between our hospitals and the regional planning commissions We would like for them to be available as a resource in our strategic planning And so that's what we're looking to accomplish with that's what we're asking great. Perfect. I was just Echoing you from yesterday. Thank you. I appreciate that So serendipity, thank you for coming down. Perfect. Good. Now back to Oh my gosh, this is a console with w numbers Do you know any of our members? Oh, we're good. Oh, we've got lots of those that seems to be the one Oh, yeah, so the bill We don't do it. We just don't have it. Oh, I do it. 243 is being evaluated now. We're going to fix a little section of it. I think it's working. Yeah, because I kept saying what happened to my bill? I came back prepared to get approved. Send it on the floor. It's an approach. Who it is. Yeah, I was told it was 26 members. I said, no, there's only 23 I was already to do the nursing compact It wasn't a calendar yet. Where is it actually working? Approves. It's an approach. Is it? Yeah, no, is it? No, I know I asked to do it. We don't get that thing out. Okay, that's all. That's a bill that shouldn't be lost in the more acid bills. Oh, I know what the problem with that one is. We can't get the drafter this week. How drafter? That's again. Oh no, that's inappropriate. We would tell, I believe that's what Faith told me we couldn't get the drafter. But no, we've got her one other time, so we're going to try and get it in this week. All right, I think that's it. It's out of the committee of jurisdiction and in a money committee, so it's It's made cross over, right? Well, if I get it out one a week from Friday. Okay, I still, sorry to interrupt. You have a problem. But we're going to move on to S218. I should never brought that up. Now, with this language that we have in front of us from Commissioner Squirrel, do you feel comfortable walking through that? I can point out the changes to you. So there are changes in the membership specifically on page two. There's a representative appointed by the insurance plan with the largest number of covered lives in Vermont. I think a previous version had a representative from maybe two or three of the largest health insurers in the state. So this is the largest one. Thank you, subdivision R, yep. And then in subdivision S, two persons who have received mental health services in Vermont appointed by Vermont psychiatric survivors, including one person who has delivered, including a person who has delivered care services instead of, oh no, it could, that works as is. Okay. And then subdivision T, a family member of a person who has received mental health services appointed by the Vermont chapter of NAMI. And lastly, in subdivision U, one family member of a child who has received mental health services appointed by the Vermont Federation of Families for Vermont's, sorry, for Children's Mental Health. And then if you remember the previous version you looked at, it kind of created like an executive committee and then a committee. So that structure is gone here and just has straight membership. And the staffing, not the staffing, the chairs have changed. So previously there were co-chairs of the Department of Mental Health and Health. This version has the chair as DMH and the vice chair as the commissioner of health. There's also some changes. A previous version had a language around ensuring, let's see, at the top. Yeah. And subdivision A and the creation, a previous version said there is created a mental health integration council for the purpose of ensuring that all sectors of the health care system actively participate. So this is saying helping to ensure. And similarly in the purposes and duties of the council, one of the powers and duties had been ensuring the implementation of existing law to establish full integration. The language now reads helping to ensure. Okay. This is the, remember, the bill that we had, 218, was a placeholder. And then we asked the commissioner to come back with some language that we could send to the house because I think they may be forward, but go ahead. How many, I've never really seen this before. Any other members, the co-chairs, DMH appropriate? Where is that? On page three, W. That's W. W. Have you ever seen it? Wait, wait. Does that on hers? I don't have that. I don't have that on the version I'm working. Is that, I don't think you're looking at it. I know, look, one point. No, no. You're looking at, go to the bottom of the commissioner's swirl. Yeah, go back to your doctorate. Okay. It could be a mile away. Yeah, just the bottom of the doctorate. Yeah, but 1.1 does have, I did the same. It does. And that is something I see from time to time. So I think originally that's what the commissioner had wanted. Yeah, not under came it. No, I saw that and I was like, what's that? That's what we did because we weren't sure. You're right, that we knew what we were doing. Okay. Is there still 23? Yes. Well, actually 24, there's two persons on S. S has two. All right. Well, good. The W is gone. First responders? Huh? Did this feed out the first responders? Yes, it does, by one, by one.  They're going to say, that's too many people. That's a lot of proteins. It's not out, there's no proteins on this. No, they're all like, they're family members. The family members, that's the experience. Okay. I was getting that 35 years ago as a district commissioner. I will say that having gone through the whole process this fall, I was part a little bit of it. That having this continue, the work continue on mental health makes a whole lot of sense. And the more the merrier, I guess. If Commissioner Squirrel is happy with this, I think. She's willing to testify on the phone right now, but I don't know if we need that. Can I do one small change? Uh-oh. Very tight. Okay. Letter O, this is executive director. Should be CEO or chief executive officer. Or did, or did. What is it? What is it? Her title is Chief Executive Officer. Not executive. Oh, CEO. Okay. Chief Executive Officer. We'll take that. It's, that's an act of violence. Yeah. Okay. Act of violence. Yeah. Fine. Just fine. Okay. So should we ask Katie to put this into final form for us? Please. Are you wanting to vote it out today? If you want to, we can huddle in the corner. Well, I have my laptop, so. Okay. I mean, the other thing is changing that chief executive operator. Right. Well, we need that clean copy to take out. But yeah. Okay. Let's do that. I'll vote on it. And I have Janet coming in to talk about 297, which you all remember was the restructuring of the agency of human services. And I, so we took a testimony on that and we as a committee decided that we would rather have some decision making going on rather than fail, complete, go and do it. We said we'd like to have some discussion about what is the best way to do this. Jane Kitchell's doing this. That bill, and Janet's going to come down with it at quarter of. Okay. I've got to leave. It's early because I've got money chairs and I've got a chairs meeting, which means money chairs has to start early. Okay. So, and I need you to work. You weren't here when we started this. When you started, when you, were you here when Secretary Smith testified on 297 and, and former secretary was seen testified? No. So you're, but you, I do want you to look at it. This is said in Kitchell's bill. Yeah. Yeah. And setting up in Department of, Department of Health. Yeah. So our discussion in here was that with the, all the things that, and we heard from folks that with all the things that have been going on to integrate healthcare with everything else, services that we shouldn't act preemptively and just not do it. We should tear them apart. That's it. And then, and then the, they never stopped us before. I mean, those departments have had so many names. Well, GovOps wants this bill. That matters. So if we can look at it and agree that it makes sense, we can simply transfer it with all of our priorities, we can transfer it down there and have them work on it and go to close. It's probably not a one year, you know, it's a statement. It is a statement. So that, and we'll finish, try to finish as many as 85 tomorrow. And we'll, then we're really digging in on 290 in the next day. I am not going to suggest at this time that we meet at 830 on Friday, but that we all be on time at nine o'clock tomorrow. And I was, I was almost embarrassed today. And I showed her cat pictures and she chit-chit really. She showed the cat pictures. I thought about it. The cat and the saint was the best. I had a room full of lobbies when I walked in the door. I know it's hard. It is hard. And I know, and I know you're rich, you're busy and everybody gets delayed. I understand that, but to borrow the next day, tell them we can't. I'm always part of it. When I left the cafeteria, if I had come straight, I would have been on time. I was waylaid by three different people, neither of whom I felt comfortable blowing off. I know you can't. I know you last week, I locked myself in the ladies room. It's the only way I could get away from you. Okay, so Katie has miraculously put together a draft. Not all. Do we refresh? Okay. It will be draft 2.1. Okay, we're almost, you've got a minute. Here it is. I don't have it. I have not posted it yet. It just takes me a minute. I wasn't hurrying you. We're only changing one word, right? No, no, the draft I was working on is somewhat different from what you said. Go to the bottom and hit Sarah Squirrel. Oh, I was that. Okay. The only thing I thought we changed was Okay, now you hit refresh and under Katie McClendon, we should have 2.1. 185 draft 2.1? 218. Oh, 218. It's not there. It's not there because we haven't put it there yet. So hang on a minute. This is how long it takes up scope, it goes so fast because sometimes drafts are funky. It's like that. Got it. Okay, let's look at it briefly. Katie, this is what we just looked at. This is what you just looked at. It's in an amendment format now and you've changed executive director to chief executive officer. Subdivision. Oh, okay. I think that we approve this and recommend it to the full senate. Discussion. Okay. Senator Cummings. Yes. Senator Ingram votes. Yes. Senator Cormack. Yes, Senator Westman. Yes. Senator Lymons. Yes. Is a reporter? Okay. Get easy ones. A very good, thank you Katie. Okay Jen. Okay, I'm gonna. Okay. We have draft 1.1 of 297. Yes. And I'm looking at it And this is the reorganization, and can you just tell us what we have there? Jennifer Carby, Legislative Counsel. Yes, it's a pretty basic working group. It just would create a working group to develop proposals for reorganizing the agency of human services. It would have on it the secretary or designee, the commissioner of each department within the agency, or their designees and other interested stakeholders. It directs them to consider options for reorganizing, restructuring, or reconfiguring the agency of human services and its departments to best serve her monitors, including consideration of whether the agency should be divided into two or more agencies, and if so, how they should be organized, how to improve collaboration, integration, and alignment of services across agencies and departments to deliver services built around the needs of individuals and families, and how to minimize any confusion or disruption that may result from implementing the recommended changes. I have a report come back in by January 15th of 2021. Yes. The option appropriations is not going to like this. But, Jennifer. Why are we not going to like it? Well, because they're sold on having a department or agency of health care. So. This is a strike all. The original actually did the reorganization. This is right. It did the split. It didn't, you know, and it sort of put departments in both. But I think some of the testimony you heard was, well, maybe you should take a piece of this and put it over here and maybe you know, this says that they have to this council has to consider it. Yes. Yeah, of course, there's nothing stopping them from considering it anyway. Yeah. 20 year build. Well, they aren't in the south. I don't think it's just that, you know, in great respect for other people. For former secretary received in it. But he was of a time where it was a different world of health care than it is. And we were headed in a different direction than there is now. So, you know. We could, I'm saying before we act on this, what we could do is we could put a choice in that should and add one of the choices being what is in the current bill. That they, I think that might ameliorate some of the problems that we face going down the hall. You put the whole bill, that whole of the bill inside this one. No, I think just consider whether there should be an agency of health care administration with these departments in it and the agency answers with those departments in it. I think we should say that. I think we should say that. So we're not going to vote now? No. No. Okay. Well, we are, we may. So I am supposed to be in GovOps with this bill this afternoon. I don't know. What I would like to do is, I don't know if there's any way to get that bill to us that we can look at and say yes, we agree to it. Because what we can do is pick it up and in on the floor, we can have it committed to GovOps with our recommendation intact. So to clarify then, would you be looking to put in just an additional, so keep the weather, AHS should be divided into two or more agencies. And if so, how they should be organized, whether it should be split into an agency of human services. Should I just put it in as another bullet saying sort of whether it should be this specific way? Yes. So Dr, that respects the bill that's there. I think the bill that's there is extremely detailed. Yes. And it leaves out a lot of things that we've done in the past. Before, are we done with this? Not yet. I mean not done, but I mean done. Discussing in right now. Not yet. I just want to make sure that we are somewhere. So we are going to see something. Can we see something? Yes. I'm going to work on it in the next seven minutes. And then is the plan that we would, if we agree. It's mostly done. I'm missing one piece. We can simply, I can stand up and ask to have it committed from this committee to that committee with our recommendation intact. But we need to vote on it. We are really going to vote on it. So we want to wait for a hard copy and we can recess for two minutes and vote on it. Or meet in the club room. Let's try to see. We have to see. I think we have to see a hard copy. OK. Another roll. OK. So if you go to page two, we have still whether the agency of human services should be divided into two or more agencies, and if so, how they should be organized, and then a new two, whether the agency of human services should be divided as follows, an agency of human services comprising the Department of Corrections, the Department for Children and Families, the Department of Independent Living, which would provide services to Vermonters who were elders and to individuals with disabilities. That one didn't seem as self-explanatory. And the Human Services Board and an agency of health care administration comprising the Department of Health Access of Mental Health and Substance Abuse of Long-Term Care and of Public Health, the Health Care Board and the Vermon Health Benefit Exchange. And then I just remembered the others. Excellent. That's much better. And how to minimize any confusion or disruption that they don't feel like. Right. Yep. So it keeps the others. That's all good stuff. That's all good stuff. OK. How do we feel about this? Is there a motion? I would move the bill to pass as part of the language draft. 1.2. No. Well, I effectively moved again, so I'm going to. I want to be careful about our process here. Or I'm going to send you a new one. The process so that it's all in. OK. We will meet in crossover if it goes to GoVox and then it gets to a probes by Friday. We're good. OK. So process-wise, we can do this. Vote it out and pending notice, we can have it put into GoVox today. We're good. Do we want to still call it health care and this relating to the agency health care? Oh, we can change the title. I'm going to change the title. Yeah, I've seen what we're going to call it. Reorganization of the agency. Reorganization, yes. Reorganizing the agency report. What? Yeah, no, I think that title. What? The agency health care. The agency health services or reorganization. Yeah, no, it's fine. Right now it's the agency of an app relating to the agency of health care administration. Do you want to keep that title or do you want it to say something like an act relating to reorganizing the agency of health care? We want the new title of the order. OK. They can get a new title of the order. We'll fix that. Reorganizing the agency of human health services. Yeah, I'm going to say an act relating to reorganizing the agency of human health services. So that's good. So it will be 1.3 now. OK. I was a little bit of a technical one for harshness of Doug's because I thought that, from my point of view, he was at a different time. Yeah, I understand that. I'm going to reword my motion that we move that we recommend the passage of what's the number? Oh, to S297. S297 as per draft 1.3. Yes, just sent to Dory. And she'll post. OK. Has the name change for the bill? OK, I'll go find Senator Cummings. Senator Ingram votes yes. Senator McCormick? Yes. Senator Westman? Yes. Senator Lines? Yes. So the plan for this bill is I need, who's reporting it? Who wants to report? Who wants to get in trouble the most? I guess I do. The benefits being the chair. Thank you very much. Dory, I'm going to report it, but I need a clean copy. And I'll take it upstairs, and then I'll get the pending notice language when I could do that on the floor. It's a clean copy, right? Yes. And do I have a copy? Because I'm going to go grab it. Me too, because I'm going to put it on the bill. Yeah, good for the secretary. Is everybody a copy that you can? No, three of them, yes. And are you OK if I send this to GovOps? Or do you want me to wait a little more? I'll send it to Gail for this afternoon. Right. Great. I'm going to go get lunch. Yes.