So, in this chapter, Rachel's is investigating or is wondering what is morality. He wants to give a minimum conception of morality. Now, to be clear, he's not trying to define, you know, or trying to give you the moral theory right at the beginning and then, you know, kind of leave everything else at that. Now, he wants to ask the question of what would be kind of like the bare minimum that's required for a moral theory. Now, you know, if you're taking notes and you should be taking notes, immediately you ought to go to your notes and write down, for the purpose, Rachel's is trying to provide a minimum conception of morality and you should especially go to your terms and write down minimum conception of morality. And if you've been skimming after this point, you would already know what that is and so you should write down, write that down too. Now, Rachel's doesn't give us a definition of it right off the back. However, he does give kind of a working definition of morality. Now, needless to say, this definition is a little vague. In fact, you might think that this definition is so vague that it's really pointless to ask the question about morality, ask anything about what morality is. Well, guess what? You already have a moral theory. In fact, well, I mean, I know this because you have goals. You have values. There are things that you're working for. So you already have a conception of morality. The question is, how well have you thought it through? Well, to illustrate what Rachel's thinks is this minimum conception of morality, he uses several cases. Now, I am absolutely certain that you are not going to agree with all the conclusions that Rachel's reaches and that's fine. I'm not in the business of trying to tell you what to believe. However, if you're going to reject one of the conclusions, you have to show where the error and reasoning is. You have to provide an argument. And we'll see what that involves as we proceed through the semester. So the first case that Rachel's looks at is this baby Teresa case. Now, I'm not going to recount the case here. You can read the case as very clearly explained. But he's going to compare and contrast arguments for and against transplanting all of Teresa's organs for other children. Well, Rachel's provides an argument with a conclusion that we should transplant Teresa's organs for other children. The argument has, it's pretty simple, it's two premises and one conclusion. Now, premise is a reason or piece of evidence, a belief or an idea that is going to be used to justify the conclusion. And the conclusion is what is inferred from the premises, okay? I have provided this argument in numbered premise form. And the reason why I did that, or numbered proposition form, the reason why I did that is for ease of reference. So the first premise is pretty straightforward. In fact, to disagree with this premise is at best confusing. At least on its surface, we tend to use this premise all the time. Now, we might question it later on during the course of the semester. But for the moment, it seems pretty straightforward. Now, the second premise is probably more contentious. It's not contentious that the other children would benefit from Teresa's organs. That doesn't seem to be a very open question. But the second part of this premise is very much open for contentious. At least the thing that Rachel thinks people will argue against. And then finally, we have the conclusion that we should transplant Teresa's organs. Now, as I said, this argument is given in numbered proposition form. And it's also a deductively valid argument. And deductively valid means that if the premises are true, then the conclusion must be true. Now, what this means is that you have the conclusion, and I'm betting at least half of you disagree with the conclusion. You disagree with the conclusion, that's fine. Like I said, I'm not here to tell you what to believe. Now, since it's deductively valid, you have to show which of these premises is false. You have to show which of these premises is false. So it's in deductively valid form, and I want you to look real quickly at the parenthetical notation at the end of the conclusion. Now, the parenthetical notation will tell you from which premises that conclusion is from. In this case, premises one and two. And it will also tell you which inference rule is used. In this case, the MP stands for modus ponens. Now, modus ponens is probably the most widespread use argument in history ever. You've used it yourself, although you've never called it modus ponens, I bet. Now, modus ponens is really simple. Modus ponens has a conditional. And conditional is a proposition. If we're using P and Q to represent propositions, a conditional is if P, then Q. So if Rex is a dog, then Rex is a mammal. And the first part of the conditional is sufficient for the second. Meaning that if the first part is true, then the second part must be true. The first part is called the antecedent. The second part is called the consequent. So in this case, we have the conditional, if P, then Q. We have the assertion and the antecedent. So we have the conclusion of transplanting Teresa's organs. Now, like I said, I bet about at least half of you are going to disagree with Rachel's conclusion that we can simply just transplant Teresa's organs. And to do this, you have to reject one of the premises that are used to infer the conclusion. And the first premise, like I said, is pretty solid.  What that means is, since it's a condition, you have to say an action would benefit somebody else, would benefit people, not hurt anybody else. And yet we shouldn't do it. That seems strange. That seems strange. So the first premise probably isn't the one you're going to go after. It's probably going to be the second one. And usually the way that most people try to disagree with Rachel, as they anticipate this, and wisely so, is to say that, well, death, somebody is harmed in transplanting Teresa's organs, namely Teresa, because she's going to die.  So the rejection of the second premise usually is something like, well, Teresa, in fact, will be harmed because she will die. Now, Rachel thinks this isn't necessarily the case. And he just wants you to consider this. He wonders, so he asks the question, what does it mean to benefit from life? So what all that Teresa could do is, well, nothing. Her heart beats and her lungs breathe. Blood flows through her body, but she really doesn't have a brain to have anything like thoughts, beliefs, feelings. She can't relate to other people. Rachel suggests that Teresa, in fact, cannot benefit from life. And what he also does, he's not explicit about this, but what he also does is he suggests that, if something can't benefit from life, then it can't be harmed. Then it can't be harmed. So the idea basically is, well, Teresa can't be harmed. Why? Because she has no benefits. There's nothing that is going to be good about her living. So Rachel's counters here is to say, yeah, you suggest that Teresa can't be harmed, but with this definition of benefit and saying that it really benefits life and having thoughts and beliefs and relationships with other people, the burden is for you to say, well, Rachel, you're missing something such that there is a benefit of life that Teresa has that she would lose transplant of the organs. But that's kind of hard to put together. Well, the next worry that Rachel's is going to look at is using people. So somebody objecting to the conclusion that Teresa's order should be transplanted suggests to say something like this and say, well, look, if we're removing Teresa's organs, then we're using one person for the sake of another. And that's wrong. And this idea is really prevalent in our culture. We really don't like the idea of using anybody else or we especially don't like the idea of anybody using us. So we have lots of laws that try to prevent using other people. And we generally tend to stay away from or express disgust for people who are obviously users. Even being called a user is an insult. So this idea is appealing in our culture. Now, what something Rachel's suggests is that we in fact are not using baby Teresa at all. So we want to be really careful here in understanding what Rachel's is trying to say. Rachel's is not suggesting that it's okay to use people. No, Rachel's agrees that it's not a moral thing to use other people. Now, what he's suggesting is that Teresa would not be used at all. So the way that Rachel's goes about doing this is he tries to understand what it means to use somebody else. Now, in most of the cases we talk about using other people, we talk about cases of manipulation. We talk about cases of people performing an act to meet our ends and our goals and our needs. And specifically, though, those times that the people that we're using do not benefit from it.  So what Rachel's points to here is that the idea of using another person is closely tied to the idea that that other person has autonomy. And autonomy is the ability to make decisions for yourself to take those courses of actions that fulfill your desires and values or to do what you want to do. It's kind of the simplest way of saying that. So Rachel's constructs an argument. This first premise he says, if one person uses another, then that means that the second person, the person being used, has autonomy. Has autonomy. And the idea is that if somebody doesn't have autonomy, you can't use them. You take a look at these plants out here. These plants don't have autonomy. They don't have free will. They don't make decisions. So there's no way that I can really use the plants in a way that violates their autonomy. It's not in the way that I use persons. I might use the plants for food, but that's part of the function of a plant. I am not myself prone to do this, but if somebody wanted to get a tan, they could lay out in the sun and so they could benefit from the sun's rays. But that doesn't use the sun because the sun doesn't have autonomy. So if you're using a person, then that person has autonomy. Well, the second premise is that Teresa doesn't have any autonomy. Simply because she lacks the hardware.  In fact, in the case, she died in nine days, something like this. So she not only did she not have the time to develop autonomy, but the way that her brain was formed is that she could not develop autonomy. So the idea is that Rachel is suggesting is that Teresa never had, nor could have autonomy. Well, the conclusion that follows then that Teresa simply can't be used. Now, this is kind of an extreme conclusion. Mostly because it doesn't really matter what you're doing with Teresa, but you might wonder about that. You might take a look at it because some really scary scenarios start coming to mind rather quickly. So here's Rachel's claim is that Teresa can't be used because she doesn't have autonomy. And again, take a look at the argument, look at the parenthetical notation. This comes from the first and second premise. Now, this time we're using an inference rule called modus tollens. Modus tollens is a little different than modus ponens. Modus ponens is if P then Q, given P, we conclude Q. Modus tollens kind of goes the other way. Say, if P then Q, we know not Q, therefore we know not P. And an example of this is something like if an animal is a dog, then the animal is warm-blooded. Jaws the shark is not warm-blooded. Therefore, jaws is not a dog. So this is an argument that Rachel provides about autonomy. And his point is that baby Teresa does not have autonomy, so she can't be used. The last things that Rachel considers is just the pretty straightforward prohibition against killing in general. We generally say that it was just wrong to kill.  But Rachel's quick to point out that Teresa's case is not a usual case. He says that there have already been everyday exceptions to the prohibition against killing. And unless you're some variety of a pacifist, you think so too.  So the idea is that it's wrong to kill you accepting cases of self-defense either for yourself or for a loved one. A lot of people argue, not everybody, but a lot of people argue that killing during time of war is permissible. It's not necessarily desirable, but it is permissible. Not any kind of killing, obviously, but at least some kinds of killing are permissible. If you think that capital punishment is something that a state can do, then you think that there are exceptions to killing. So immediately Rachel's suggests that well, we already have exceptions to killing people. So just in and of itself that isn't going to fly. So the question is whether or not killing Teresa by removing her organs is going to be permissible. So one of the things that he suggests is say, look, our conceptions of what it means to die have changed through time. Right now it's, a person can in a sense clinically die meaning that their heart stops beating but be resuscitated that their brain keeps on living so that they can be in a sense brought back to life. Used to be death was considered to happen when the heart stops. We don't necessarily consider that anymore. These days, in fact, we'll keep the heart beating in order to keep the brain alive. So the idea is that real death, quote unquote real death, doesn't occur until the brain dies. Well, in Teresa's case she doesn't really have a brain. She, her brain was never really alive to begin with. So what Rachel wants to say is that killing the prohibition he gets killing really doesn't apply to Teresa's case since she really isn't alive to begin with. Rachel considers two of the cases. And remember, when he's looking at these cases, what he's trying to do is to lay down some ground rules for what it means to have this minimum conception of a moral theory. What I want you to do is to read the cases and to try to reconstruct the arguments. Pay special attention to the terms that are being used. Make sure you identify those terms. That's going to be really important in understanding this whole process of reasoning. And what we're going to look at next we're going to look at what Rachel considers to be this minimum conception of morality. So now we come to Rachel's minimum conception of morality. Now again, he isn't trying to provide the end-all-be-all moral theory. What conditions need to be in place in order to have a good moral theory. And the two that he proposes is good moral reasoning and impartiality. So immediately you ought to go to your notes and write down good moral reasoning and impartiality trying to figure out what Rachel's means by these. So looking at good moral reasoning first, Rachel's tries to contrast good moral reasoning versus what it does not. And the first thing he suggests is that good moral reasoning is not merely feeling or he even sometimes suggests that it ought not to be influenced by feelings at all. And there's a lot to what he says of feelings are not a guarantee of truth. We feel many things and based upon that we want to act on those feelings but that doesn't mean our feelings are always justified. So for instance one of the biggest examples is hatred. It is a huge motivator for all of us.  And sometimes that hatred motivates us to do anywhere from mean and annoying things to downright violence. That doesn't mean that our actions are justified by those feelings. It's hatred. It's not a moral principle. So hatred isn't really going to do it. And by the way since feelings aren't necessarily good moral reasons for action and hatred is a feeling while it also follows that love isn't necessarily a good reason for moral action. So that's a little bit scary, isn't it? The other thing that Rachel contrasts good moral reasoning to are wants, desires, tastes or preferences. Simple things that we just want. And this doesn't always justify moral action. For instance I love espresso. Espresso to me is the reason why I get up in the morning.  So I love, I like espresso. It doesn't mean that I or anybody else for that matter are obligated to drink espresso. Quite a few people out there who I think would agree with me simply after the first time they tried espresso. You think so too. You have lots of tastes and preferences and you try to justify these actions by just the things that you like. And I'm not saying that you can't do the things that you like. I'm just saying they're not necessarily good reasons. For instance suppose I had the weird preference to randomly assign readings in the history of pencils in this course. Don't worry, I'm not going to do that. In fact I have no interest in the history of pencils. But suppose I did. It would still not be a morally justified act to give you assignments in the history of pencils. So simply a taste or a preference is not necessarily good moral reason. And by the way as I said before feelings are simply a good moral reason. That's not to say they're completely irrelevant. But there's certainly not the determining factor and there may not even be the top factor depending on what your moral theory is. Well at this point you might wonder what does count as a good moral reason. That's a great question. If you can answer that question you can write your own textbook in an introduction to ethics course. Actually it would be the definitive textbook in the introduction to ethics course. Now what counts as a good reason is difficult to say. However we already think that there are some good reasons and you do too. We have values and principles that are considered to be good ones. Liberty, equality, justice. If something threatens those then we tend to think that there's something wrong happening and we certainly have an option to defend ourselves in those cases. So yeah, we already have good moral principles that we think are good. It's an interesting question as to what justify those. Okay, that's an interesting question. And hopefully through the course of the semester we can look at reasons to justify principles like that. There is one thing however, there's an additional thing however that is required of good moral reasoning. And that's logical consistency. Now logical consistency just means that your theory produces true conclusion well not even so much true conclusions as conclusions or actions that are not absurd or not self contradictory or they don't generate contradictions. You might wonder why this is so important. It's like well if your theory generates contradictions then it's going to say such things as an act is both moral and immoral.  Well it doesn't provide a guide for action. It doesn't do what it's supposed to do. So logical consistency is going to be another big thing with moral theories. Now here's just kind of a forewarning. It's a common practice in ethics and ethical reasoning to find counter examples to moral reasoning. And the idea is is that a moral principle whether the person realizes or not is going to infer that some course of action is a moral when in fact it's not moral. So if my moral theory says that it's permissible to randomly kill every six person on the street well then there's something wrong with that theory. How to reject that theory. It's really really hard. It's a statistical impossibility for your theory to be perfectly consistent. There's always going to be some problem that comes up against. There's always going to be some issue that's going to come up against. And it could be anything from conclusions that are really difficult to accept. We just don't want to accept them to direct contradictions to absurdities. So through the course of this semester your convictions are going to come up against these problems. I promise you.  This is a course in ethical theory and not a course in who's good and bad. I'm not interested in that project to begin with and no ethical theory course can do that. So if it happens that your theory, your favorite theory of moral beliefs comes up against these problems learn to handle them with grace. Accept that it's a problem and try to move on from there or try to figure out a solution to it. The really ineffective way of dealing with that is yelling and anger that just doesn't help. First of all it doesn't help figure out where there might be a problem. So good moral reasoning what exactly counts as a really interesting question but one thing that we're really certain is true is that logical consistency is going to be a big requirement for good moral reasoning. So one condition for this minimum conception of morality is good moral reasoning. The other condition is impartiality. Now what impartiality basically means is that everybody's interests are considered equally and here we have the definition. Now stating this definition and providing a definition is one thing applying it as another because just as a matter of fact people's interests are going to conflict. People's interests are going to conflict. It's kind of the hallmark of what is this idea. The perfectly harmonious society is one in which everybody has the same interests but that just doesn't happen. People have different sets of interests. So interests are going to conflict and since they conflict at most one person's interests are going to win out or one group of interests are going to win out and it's possible that none of them do. And trying to provide a solution is nobody gets what they want. A friend of mine used to say this when he was talking about going to a meeting and here was this definition of compromise. Here's one good idea and here's another good idea. What's a compromise? Let's do neither of them. So interests are going to conflict and somebody is going to win out and somebody is not. And trying to figure out who is going to win out is going to win out. It's a very, very hard question. Those solutions that are such that everybody can win out great but they're really, really rare. Really rare. So as an exercise to really kind of drive this point home, I want you to write down your interests. Do you even know what they are? Think about what your interests are. Write them down. And to further drive the point home, write down other people's interests that conflict with yours. What do you want? What's going to make your life better? And what do other people want? What's going to make their life better? These are going to be conflicting interests and a really difficult question is who's going to win out? Why should they win out? So we have Rachel's minimum conception of justice and that's his minimum conception. Minimum conception requires good moral reasoning which includes logical consistency and impartiality which is treating everybody's interests equally or considering everybody's interests equally. Now an interesting question is whether Rachel's cases actually meet this minimum conception. Remember what I said? It's kind of a statistical impossibility that any given moral theory is going to be without any problems. If that were a case, if no moral theory had any problems whatsoever excuse me, if there was some moral theory that had no problems, well that would probably be the theory that we would teach in the course instead of a whole lot of possibilities. So you might ask yourself regarding the cases that Rachel provides how might those cases run into problems? Do they run into problems? And here's my hint, yes they do. They already run into issues that people have with regard to some moral judgments about the life and death of a human being. So I want you to think about that. Think about these cases where we talk about life and death of a human being and think about how that might run into problems. You might again also consider how logical consistency and impartiality bumps heads with your own moral theory. This is just good practice to start thinking about this. It helps you become a better person. So think about these issues and we'll start discussing these in class.


Welcome folks, we at the Dow Industries finish up 90 Nasdaq down 51, S&Ps up 8.5, gold, gold contract down $9.20, traded $17.36 an ounce, we had silver down 29 cents, $18.33 an ounce, light sweet crude up a buck and a half, a trade down to a price point of $96.75 a barrel, notes and bonds, here's a 10-year note trading down 4 ticks at $1.19.24, $30 off 12 at $1.40, $1.23 in Kingdala, Kingdala down 294 ticks at $106, $4.36, the Euro is at $102, the Yens at $136 and the British pound is at $120 to $1 US. I'm going to get over to the 10-year and the reason I want to go over to the 10-year, I meant to go over it in my program, is this, the 10-year folks last week came in with volume as it goes into its swing point. The 10-year is projecting a potential ABC structure on the way up and it's a big one, man. So pitch up. The first swing point that was going after is 1.6 million contracts. Well, we did 1.79 million contracts on Friday. That's telling me that we're going to blow that away and the B point on this is $1.26, your A point is the 1.14, it's approximately $6 which is going to get you up into the 124 area. Now if that's what you get, folks, this thing is laying out coming into the Fed announcement. So that's telling me whatever they say, okay, is that on a basis of the next two or three months that we are actually going to see rates go down, not go up. And you got to remember something, that the Fed fund rate is the bank rate, bank to bank. It's not the 10-year. The 10-year is what's predicated for all the mortgages, your credit cards, all the above. So the bottom line, if this 10-year is going to do an ABC structure up, let me tell you, that means that the dollar's topped, that rates are going to come down and that'll be saying to me that you're going to see a rally and that would be the most deviant thing the market could do, particularly because this is the worst time of the year coming right up till October. The 10-year right now is trading 2.8%. But the way it's set up, man, particularly because if we look at this again today, what you're going to see is that we pulled back, we went higher Friday with 1.67 million contracts. We pulled back today with $942,000, man. It wants higher price. Lower rates are coming at us. Deviant. Amazing. Have a great one, folks. Have a safe one. Come back and visit Tommy tomorrow morning. Kicks us off at 9 o'clock in the morning. Great show. Huge amount of earnings. Real! Look at him, folks.


Good afternoon, this is the house health care committee convening again on the afternoon of Wednesday, March 10th at 315. We are taking up this afternoon some additional testimony, not on a specific bill, but on the issue of establishing a secure residential facility. And this the house institutions committee is looking for a recommendation from the house health care committee on the proposal to construct a 16 bed replacement facility for the current seven bed middle sex facility. We have a number of witnesses who many of whom have shared letters with us, but who would like to briefly also share some thoughts in person. And again, Colleen, I'm going to look to you for some guidance. I have a list in front of me, but I know that there are several people who have submitted in writing several others because of our being on the floor who may not be available. But I'd like to turn first I believe I would confirm with Colleen, we should first be hearing from Shay Wittsberger. Is that right? Yes. Okay, Shay, I apologize if I have not pronounced your name properly I don't have I see the name on your screen is a different name. You're doing awesome. Okay, well, would you welcome on your train might turn live on with welcome you and if you would introduce yourself with your proper name I'd appreciate it. I will. My name is Shay Wittsberger. I use she her or they them pronouns, and I'm a resident of domestic Vermont. Coming to you live from outside the Putney library, because that last mile internet is not great for this purpose. I would say when you're not going to be freezing outside. Beautiful. I'm grateful. We're outside. Yeah, it's chilly but so welcome. I would like to share with you a few thoughts from my role as co facilitator of the Brattleboro community safety review project, I can send you all a link to the full document after this. This project in Brattleboro was inspired by the uprisings around ending state racist state violence, this last spring, and morphed into a facilitated town committee project through the select board to listen to our community about community safety and the existing systems of community safety that exists, what their impact is what their accessibility is focusing on partly policing but also as we took a broader lens about what's causing safety danger and harm in the community, the mental health system came into some pretty clear focus. So a couple of reflections about that I would love to share with you all as I've been following this middle sex replacement process. We listened to over 250 individual community members and over workers from over 25 organizations in our project, and overwhelmingly, particularly, generally but also particularly from people who are disabled, psychiatrically disabled, neurodivergent or self identify as mad. Folks named that one of the biggest threats to their safety in our community was locked wards and the treatment that people receive behind them behind those doors. The other person who shared with us said, our experiences happen behind closed doors. So, and we're not even allowed to have our cell phones to record them. So some of this awareness that's coming about state violence elsewhere is not available to us inside of psych institutions because we can't even record what's happening to us.  Many, many people very concerningly named that existing facilities in our area are causing so much harm that multiple different people use the word torture to describe what's happening in these spaces. And another really strong theme that came through was that there is very little accountability for that harm that's happening. There's little accountability from DMH or the institutions themselves for any harm that's happening. Some of those harms are have already as I understand been taken off of the table of the middle sex facility. Many people experience restraints and seclusion and forced drugging to be very violent, taking away their bodily autonomy which is the definition of trauma for many people. But also the presence of a locked word where your bodily autonomy is limited and you do not have control over what happens to you is really traumatizing for a lot of folks. A challenge that many people named is that they don't feel like they can access any systemic mental health care. The threat of forced hospitalization is on the table. They can't call a line. They can't go to their local designated agency. They can't access any health care safely. If the threat of forced hospitalization is present. And what these folks named to us as I'm not a psych survivor I feel like my role in this project was as a translator between what people shared in focus listening sessions and our local governance and what folks shared was that I think there is a lot of investment by the state into only the most carceral punitive locked aspects of the mental health care system feels like an injustice and that there's very little resourcing happening monetarily of some alternatives that people named would be really supportive to our community safety. Some kind of peer support on that you can call either through 911 or as an alternative a mobile crisis kind of response that's not police or crisis who will potentially take away somebody's rights. A crisis space that's not the emergency room a 24 seven drop in space that's friendlier to people in crisis than the emergency room where people also named experiencing a lot of harm and regarding beds. We know that there is the perception that there's a shortage of beds. And I think that it's arguable about whether or not an expansion of locked beds is what we need. The retreat is going to be expanding a whole new unit of I think 12 beds that plan came after or was not in in alignment with this plan for the middle sex replacement facility. People said that they don't want to go into a locked facility anyway if they need support they need support from a home like respite or trainings for the community and how we can support each other so that that's not people's only option. Many people who get stuck in the emergency room and cause this clog in the system of care don't want a locked word to be the only thing that's waiting for them on the other side of that's long terrible stay. And so we, we really heard from people that this problem of the flow of the system into and out of the ER is a concern but that more locked beds are not the solution that any psych survivors, psychiatrically labeled or disabled people, self identified mad people shared with us. And these concerns were echoed by many people who work inside the system is the last thing I want to say that many people use the opportunity of our listening project as an opportunity to whistle blow about how concerned they are about patient treatment and existing problems and how much internal struggle workers are having in acting the practices at DMH controlled facilities, people named a severe lack even as providers in accountability to the harms that people are really in the traumas that people are incurring in our current system of treatment. So as I've been following this process I've noticed that in addition to all the things that I just have been holding in the listening part of this project project that we're doing down in my community in the Brattleboro area. Also DMH has been fairly dishonest and disingenuous about some of these potential harms and concerns throughout the meetings that I've been listening to makes me feel like I really validate the concerns I heard from psychiatrized people that there's very little accountability regarding harm. In their virtual walkthrough they they omitted to walk folks through the seclusion and restraint spaces even though that's why most people were there in the chat, trying to discern about those practices. There's a lot of condescension and avoidance of of the ability for people to bring real concerns about treatment that they've experienced in these systems. And people in my community have named that they desperately want money to go to alternatives, not to locked carceral spaces that create a system of punishment for people who are in distress, frankly, but rather to totally voluntary that people can access without fear of being criminalized. This is especially true for people who are criminalized otherwise, queer and trans folks, and people of color, particularly named an inaccessibility of the system of mental health care, because of their fear of essentially criminalization, whether that's police showing up to mental health welfare checks, or being locked in a facility, however beautiful the views locks are locks. And so I've heard that there's some movement toward what I would call decarcerating the facility that's being built, but it is essentially still a large locked facility that's going to take $11.5 million away from what I see as the alternatives that my community is begging the state for. So I would implore you to read the review. It's available at battle bro.org, but I will also send a link to you all particular it's very long, I don't expect that you have time to read it all but the area about listening to people about the mental health system particularly. There are some deeply concerning quotes collected there from community about what's been occurring in the mental health system torturous treatment. And I, I can't understand how to give somebody $11.5 million you can't even account for the, the, the projects they already have under their radar they're already causing immense harm. So, I would ask that you think very critically about whether or not we need to fund the most carceral locked prison like aspects of our mental health system, or the most voluntary accessible aspects of our mental health system in 2021 when we're considering these issues on the issues about punishment and carceral treatment, and in a much more critical way, I think there are many resources available to those of us who are interested in learning about the potential harms of those systems and you all hold a lot of power so I really wanted to channel that information from my community directly to you so that you can take that read that section of the report yourself and think about it for yourself but from where I say it's an absolutely the opposite of what psychiatrists people in my neck of the woods are asking for those folks are asking for voluntary supports that are less locks and cages and restraints and seclusions and forced drugging those things are traumatizing. That's all I have to share. Thank you. Thank you for taking the time to speak with us. I'm so grateful that you all are considering this, I really am so so grateful that you're thinking about this critically. It's imperative that we do so. Thank you. Thank you. We understand you have a time time, unfortunately. That's fine. Thank you for, thank you for hanging in there with us this afternoon as we had to schedule very very much I understand the facilitators dilemma so carry on. Okay, thank you. So, with that I'm going to turn to Colleen to help guide me. I see that we have Next we'll be hearing from Calvin moan. Great. Thank you. Thank you. I really appreciate your help in navigating here this afternoon so Calvin, if you would join us I see you were on this. Oh, there you are. There you are. So, welcome to the house health care committee. And again, thank you for your patience in being heard. Turn it over to you to introduce yourself. I understand you may have sent something to us already. Some of us have not had a chance to read through everything, but we also wanted to extend additional invitations to be heard briefly. Yeah, and I really appreciate that thank you I did send a letter. But you know there are some things that I think I can elaborate on, and there are some things that have changed. Since I wrote it. Yes. So yeah my name is Calvin moan. My pronouns are he him. I live in Brattleboro. I have been in the area for nine years. During which I've been doing support and advocacy with people individuals on the individual level people who are impacted by the mental health system. I'm also some advocacy on organizational and state levels. I myself am a psychiatric survivor and here in their mental health service user. And so that's what really informs my advocacy and the peer support that I do. I am also an educator. A lot of my work right now is in intentional peer support. So, done training and workshops on just a whole range of things related to psychiatric liberation, the movement history harm reduction as it is applied to psychiatric drugs alternatives to police responses. And have done quite a bit of community building both in and around Brattleboro. And in Greenfield mass, which is where I actually am currently, because I have a hearing voices support group to do in about half an hour. So that's some context for me from for for where I'm coming from. And I've also, you know, been somewhat involved in these legislative processes before given some testimony written letters. And I, before I really talk specifically about this proposal, I guess I just, I wanted to address what is and has been difficult about this process for me because that's what I know but also I think for a lot of people in my community. And, and I mean specifically the process around planning and making decisions about replacing the middle sex facility and also just in general, DMH and the way that they have really shut out the voices of the people who experienced the impacts of their decisions of that system. During this whole course of planning for the middle sex replacement. The adult state standing committee has been trying to give input and from what I know I'm not a member but these are my colleagues and you know they're saying that that input they've been asked for has been superficial. Their objections have not been recorded have not been listened to and so you know we find ourselves at this moment here. Kind of locked in this struggle. When I don't think it needed to be this way I think that we could have had a much more participatory process. And the process that Shay was just talking about the community safety review in Brattleboro has really stood out to me as a model for what's accessible how we could be getting input from people who are, you know, the most impacted because this is, this is a process that's just really not accessible. Overall, I, you know, I come here at a certain cost to myself emotionally and energetically. I am appreciating being here I'm very grateful and I'm just saying that as someone who is psychiatrically labeled that showing showing emotion in the wrong way in the wrong place can can just be really dangerous. But for us, you know that is how people end up locked up that's how people end up in restraint and seclusion and forcefully medicated and court ordered. So as as hard as it is for me to kind of show up and do this. There are there are many who are at greater risk, and are more vulnerable. And so their voices are not hurt they're not, you know they're not at the table. So I think we need, I mean, we need a change to how this happens we need a change to this process of how these decisions get made. Because it's yeah it's just really draining. I've been a part of advocacy for years now where we've been asking for the kinds of alternatives that she mentioned just now. So instead what we get is just this expansion of the current harmful system, just more more of the same.  It is and even without the seclusion the restraint the force drugging. It is still not a therapeutic space, it is still not a residence, it's not a home. And it's not community based. So if I'm locked inside, that's, that's not home, that's confinement, that's institutionalization. It's not healing. And it's not community it's a centralized facility we're talking about quite a large facility. That's, that's just really not not home like in in any of the descriptions of it that I've heard. And yeah, and by expansion you know I am talking about more than doubling the current capacity. And I've heard that there's arguments for that based on some numbers that may not be up to date. And also just represents a continuation of a movement in a direction that is just ignoring our requests are repeated requests for more options for different options. I think to that coven has kind of shown us that these congregate settings of this size are are just not safe. I don't think we're out of the woods I you know I why does it make sense to plan for us to never have another pandemic again. People are safest in their homes for that reason and for so many other reasons, including throughout this pandemic there's been even less accountability right advocates have not been able to go into locked units to witness what's happening to provide, you know advocacy and support to those who are inside, you know she spoke to that. Yeah, she also spoke to what we have been asking for, instead, and as part of a movement that has been going since at least the 70s, none of this is new, none of these requests and what we've been asking for our new right peer have dropped in space, you know, completely voluntary supports material supports. Okay. So, if we're talking about spending all this money on something we're calling a residence that is at best a hospital and maybe a jail. We're talking about actual housing. We are in an enormous housing crisis in Vermont and have been and. Oh my gosh. Yeah, to think about putting all these resources somewhere else that that people are identifying as actually being harmful. It's, it's a betrayal of Vermonters of those who are in the care of DMH. You know the, the mental health system will say well, you know, these are folks who need X, Y and Z right they need to be in a locked facility, they need this level of support. And I will noisy behind me here, we're in the community center, I, I challenge that, you know, because I know folks who have been in and out of these systems, right, I have a friend right now who has been through residential has been through step down, you know, not because they were not, you know, they were never locked up because they were like violent towards other people or dangerous in any way. And those programs did not address any of the underlying needs that this person still exists with physical pain isolation disability lack of transportation. So, this person is still repeatedly hospitalized because they still are in distress because these needs are are still going on met repeated hospital stays are not changing any of that they're not. They're not breaking this cycle that this person is in. And, and when I'm talking about my friend I really could be talking about you know a composite of half a dozen people I know would fit the same example but you know this is a friend who would prefer to go spend time at a listen, which is the pure respite in Vermont to two beds for the whole state. It's often not available there's, I think the waiting list is usually about a month. And so yeah is going through these repeated hospitalizations that are traumatizing that are expensive. And meanwhile is seen as failing right failing to recover, because what's being tried over and over again isn't working and I think it's time that we try something else. So, the proposal is meant to address this problem of flow through the system and capacity of, you know the inpatient units and the ER's. There are other ways to address that that are not expanding the existing system that is not addressing the harm but is actually causing the harm, because it replicates itself. You know, analogous to like the prison system which locks people up there by kind of breaking up families breaking up communities. Breaking up those those natural supports that people have, which leads to just further incarceration. We're looking at a really similar kind of structure. We're looking at alternatives to the emergency room, which would then relieve the pressure on those long emergency room stays we keep hearing about there's this emergency room problem people are staying there too long. Why are we not talking about the problem of nobody wants to go there.  If you're in any kind of extreme or altered state if you're having some kind of crisis. There's no reason for us there, but put us in a room and tell us to wait a few days. Yeah why is that not what we're talking about as the ER problem so I'm suggesting and many many of us have suggested. If there are more alternatives more options that is in fact what's going to relieve that pressure and that capacity problem on the current system. And is going to start to stem the harm and the trauma that we are repeatedly experiencing by going through the system again and again. I think that's all that I had. Okay, well thank you. And I appreciate. I appreciate you being willing to share your perspectives and your voice with us. And in the interest because we do have three more people who have asked to be heard. I'm going to stop there for now and not open it up to further questions, but to thank you and. Yeah, I really appreciate the opportunity. And I'm glad you're doing this. I'm glad you're hearing from folks. Thank you. Thank you very much. Take care Calvin. I'm going to look to Colleen to help guide me. Next we'll be hearing from Emily, Megas Russell, resident of Brattleboro. Great. Thank you Colleen for your help. So, Emily, Megas Russell. Welcome. I see you on the screen now. Folks, can you hear me okay. I believe we can. Great. Thank you so much for hearing from from us and from me. Let's see, I'm just setting my screen up here. Yeah, so I am Emily Megas Russell. I am a resident of Brattleboro. I'm also a licensed social worker clinical social worker. I've been licensed for over 10 years and I've worked in a variety of different clinical and administrative capacities across the field of mental health. I've been in Vermont for about 10 years so been doing that in Vermont for that period of time. For seven years I worked at healthcare and rehabilitation services of southeastern Vermont. HCRS, which is one of the largest agencies designated by the state to provide mental health and addiction services to Vermonters. I held a few different roles in my time with HCRS. For the sake of this testimony, most notably I was the program director at Meadowview recovery residents in Brattleboro, Vermont, which is a unlocked intensive residential program for adults with significant mental health needs that were stepping down from inpatient hospitalization. I'm the director of residential services at HCRS and for several years I oversaw the agency's five residential facilities. These are residential facilities are on the same spectrum as the middle sex facility that we're discussing. So I'm quite intimately aware of what's going on inside of these facilities and how they're managed administratively and clinically. I also have a lens that I want to speak to this project from I worked with the metal sec facility I've worked very closely with DMH as well, because all of these programs are overseen by DMH. I was in constant dialogue in those roles with the department around around bed capacity and level of care coordination. HCRS is the quality assurance manager overseeing clinical quality of care which also bled into some of the content here in regards to residential care. But as the director of residential services at HCRS I had the privilege of working with individuals who are experiencing mental health crises and extreme states in these residential environments that were unlocked and hands off so quite notably significantly different than what's being proposed in the middle sex facility, which is a locked unit that allows restraint seclusion. And I know there's maybe a change in what is being proposed with involuntary medication. And with seclusion and restraint just to just because that's only been announced yesterday, but that's something okay great important to be clear. Absolutely thank you. And as I just said I also work closely with the DMH and coordinating level of care needs, you know these programs are far from perfect they're absolutely, you know, subject to some of the very same challenges that Calvin Calvin for example just spoke to in terms of congregate environments and really needing we really need to support people in getting housed and staying housed. All people, regardless of what the physical health abilities or disabilities are mental health needs are, we really need to be focused on supportive people and accessing housing and remaining housed. So these residential programs you know I certainly don't want to pitch them as perfect on any level that the unlocked intensive residentials. So in these programs, the fact that residents were able to live in a home like setting that was not locked in which they were not effectively imprisoned. And that were hands off, meaning no restraint seclusion staff were not trained in physical de escalation or restraint seclusion, and no for struggling used. Critical factors and honoring the human rights of the residents and even in these settings we really struggled to remain person centered and to support folks in being self directed in their own care, because these programs are really paternalistic and fear based in the way that we relate to folks living with extreme states and mental health needs. And, you know they can really serve to uphold violent stigmas against people who experience extreme states, very, you know very small percentage of people experience violence. Or I should say very small percentage of people are violent people with mental health needs and who are psychologically labeled and we know from the research that folks who are emotionally labeled are much more likely to be victims of violence than they are perpetrators of violence and frankly, what we're talking about here when we're talking about restraint and seclusion and for struggling is we're talking about state sponsored violence. So although I no longer work in community mental health or residential services I currently have a private practice where I do work with folks who also experience psychiatric hospitalization imprisonment.  And I oppose the building of the first one, frankly, my opposition is based in my experience as a clinician, working with people experiencing extreme states and psyche, who are psychologically labeled. So it's rooted in my experience as an administrator of residential programs with a working understanding of the great expense that this project would incur to the detriment of those it proposes to serve and to taxpayers. And as an activist for human rights with an intimate knowledge of the grave risk to vulnerable Vermonters that this facility poses. In the unlocked hands off residential programs we admitted folks directly from locked inpatient facilities. So this means that many folks who stepped down to the residential programs that I'm talking about the intensive residentials that are unlocked and do not use restraint seclusion, or for struggling. Many of these folks days weeks before had experienced restraints seclusion and voluntary medication in the hospital. Right. Not much had changed about them. The first resident was the environment that they were in. And many of these folks are very able to be successful in an unlocked environment where restraint and seclusion were not used. And at the time this was well before middle, middle sex existed. At the time meta view recovery residents was considered, along with second spring, were considered the most intensive, the most restrictive, the most safe or secure environments that we had initially, meaning that folks who are presenting with some of the more extreme states that had been hospitalized for years, one client over a decade. Right, and this is when the state hospital was still around and we were still doing that in the state. We are still doing that. But that was much more common practice before Hurricane Irene took the state hospital. The thing is that we had folks who had been hospitalized for decades, over a decade one person I'm recalling, and some for many years who had experienced restraints, restraint seclusion and forced drugging. Pretty chronically in fact as part of the hospitalization, we're able to step into a unlocked hands off environment. I think that's something that we have to really ask ourselves, when we are challenged with this sort of argument that we need these facilities that are able to take people's human right violate people's human rights, right, that we have many many examples and I'm telling you at this program so I was very much in touch with what was happening in regards to individuals who are coming to us after many years in these hospitals having experienced a lot of violence who are able to live successfully in an environment where staff were not trained or allowed to use hands on techniques. So, you know, a lot of people argue that there are just some people who can't stay safe or we just need these kinds of facilities and I really I will say in my years in these programs and working in mental health, there of course are moments of escalation and there are some moments of violence. But my opposition to this project is not rooted in a naive belief that violence is or will not exist. My opposition is rooted in a nuanced and complex understanding of the root causes of violence. A clear vision for resources, supports and projects that address those root causes and actually reduce violence. Right and I'm happy to talk with folks, you know about how do we as a culture address violence and cultivate safety this is a huge focus of my clinical and activism work. So if nothing is clear, further legalization expansion and capitalization of state sanctioned violence in the form of carceral approaches to mental health and safety will not lead to an overall reduction in violence. And, you know, as I think about this project and the proposal I think about the sort of, if you build it they will come like, if we allow this facility be built, the Department of Mental Health will fill it with human bodies. 100% and those human bodies will be forced to comply and obey, and the mechanisms of force that will be used have been called torture by the United Nations Commission on Human Rights and the very people that this project purports to serve. As Calvin and Shea both shared, this project is not bold. It is not brave. It is not visionary. It does not matter how comfortable the furniture is or how brightly painted the walls are if people are trained and expected to violate the human rights of its residents as part of the course of treatment. We're building a prison, a place that sanctions violence and torture, and we must stop saying otherwise. And the worst, the Department of Mental Health in the state will profit from it, actually not worse, but in addition, there will be profiting from it, the beds will be filled and I don't believe that Bermaners mental health will be any better off for it. Alternatives abound, and as Calvin expressed have abounded since the 70s and actually since I believe the beginning of time. In other words, alternative ways for communities to support and actually show genuine care and consideration for the mental health of its community members and all levels of care and all levels of entry into the system. I think the what Calvin mentioned about alternatives to the ER, you know, emergency rooms around the state have complained for years and years and years about having to deal with people who have mental health issues. Why have we not created an alternative if we don't believe that the hospital is the right place for people having a mental health crisis. Why haven't we created a viable alternative, right. It makes sense to me that a community, you know, we couldn't, a community couldn't not have an ER, right, could not have a place for people with physical health emergencies to go and get care. Why are we okay with us not having mental health alternatives, if in fact the ER is going to, you know, convince us that they're not the appropriate place. And I don't believe they are the appropriate place to agree with them. So I'll just end by saying, you know, I urge y'all to do the brave bold and courageous thing and to stop this train of motion. There are dozens of other visionary, humane, safe and life affirming projects that could be funded with this large amount of money. I urge you to use your power in protection of human rights and to demand that Department of Mental Health revision itself in alignment with the actual and expressed needs of those with lived experience of psychiatric labeling involuntary hospitalization and torturous forms of coercion and violence. This facility is on the wrong side of history. We're going to take a couple of brief questions, but I am going to insist that we hear from our both our witnesses who have been waiting. And so I'm going to ask representative boroughs and represent Golden and the responses to be relatively brief, because otherwise where I feel like we will be disrespectful to others who have waited all afternoon representative boroughs and representative Goldman. Thank you. Thank you for your testimony. My question is, do you know, do you know at the top of the head of your head, what your success rate was and what it was based on. It's a great question. I don't you're talking about the residential facilities right. Yeah, it's been some time and that I've been in that role and I've said I oversaw five programs and there's just so many numbers that I couldn't accurately represent, you know, and I don't I also as I said briefly I don't want to misrepresent either and say that, you know, rainbows butterflies kumbaya right like, you know, the, the unlocked intensive residential facilities not only they have their own struggles but they also, there are folks who left those facilities and had to go back to the hospital for example for a number of reasons right and so those are definitely. There are situations of that what I will say is that the success of these programs this is qualitative not quantitative of course, the success of these programs really had to do with our ability to engage the individuals who are living in them right and that's a very dynamic conversation in terms of what that looks like, but I will say that even as an unlocked facility, and even without any trained or sanctioned use of restraints inclusion staff never put their hands on a client, a resident in those facilities clients consistently told us it felt like they were in a prison right and we consistently had to you know because, although it's a voluntary program, very few people that are put that are like have this as the option on their table have another viable option. Right. Like, it's middle sex facility or bust for many people, right, or it's meadow view recovery residents or bust for many people for a number of reasons. A lot of them economic, in addition to no other reasons and so the point that I'm trying to make here is that some of the factors when we were able to be successful, which really looked like folks stepping out of the residential facilities into communities had everything to do with how much in those residential facilities were able to engage people center their rights and their needs and help them access a community. Right. You know, part of our treatment plan for access in community would be things like go to the co-op every day and buy a carrot so that you would see the same person every day so that you feel connected and part of a community because these programs are our institutions right, and they institutionalize people and so it makes it even harder for folks to access their own communities or feel part of a community. My question is really brief. I was looking for your testimony I found it very compelling and on our website it looks like did you do a written submission on February 9. Yeah, we click on that it goes to the committee website so I'm not sure we have access to that and I was hoping that maybe you could resubmit or we could have it posted. Just so I would be able to review it. So I'm not sure where that stands, but that would be helpful. Sure, I would have I have Colleen's email because she started out with Colleen. I can just send that to Colleen. Sure. Thank you so much. Thank you so much for hearing us. Thank you. Thank you very much. Colleen, I believe you west timers to be heard next. Welcome Eva. Welcome to the health care committee. Thank you so much for for hearing me this afternoon and for hearing all of the voices that just came before me this afternoon. My name is Eva Westheimer and I'm the programs and volunteer coordinator with out in the open. Out in the open is a statewide and regional nonprofit organization which works to connect rural LGBTQ folks together to build community visibility knowledge and power throughout our state and region. A part of our organization and our community we work towards health justice. What that means to us is we're working towards a day when all people in our community have the economic, social and political power and resources to make decisions about their own bodies and health regardless of their identities and experiences. And that's a big piece of how we focus our work and talk with our community members in in the community. We know that with pressure and community organizing from the community as we've talked about this afternoon that the proposed replacement middle sex, middle sex facility has already altered their plans right within the respects of these very harmful and torturous treatments such as seclusion restraint and forced drugging. Those changes we know have happened because folks within the community, such as the folks who have you heard from today have been reaching out tirelessly to express how these treatments are continuously harmful. We continue to oppose the new facility. As the as our state needs to focus on these alternatives such as what we've been talking about as peer respite community supports and long term housing. People need care, our LGBTQ community needs care and what we need now is the funds directed in that right direction. As we wrote to you all in our letter, the ways that the psychiatric system has pathologicalized LGBTQ folks over time is well documented. We know that facilities like these and involuntary treatment impact our LGBTQ community members, many within our community connect with us and share their experiences, share how these systems have harmed them and have created long term trauma. We know that this facility will continue this proposed facility will just perpetuate that harm. Our LGBTQ community members need to be prioritized with care and healing. People's mental health is not solved by pathologicalizing and incarcerating our community members when they say that they're in distress. We need to listen to folks and and take what they're experiencing in hand. Facilities like the proposed one don't address suicidality, poverty, trauma or structural marginalization. Instead, it perpetuates and increases all of these things, whether it looks like psychiatric incarceration or through criminal justice incarceration. We also know several things right we know that the current middle sex facility must close. We know that that's why we're here, you know, and we also know that the state has an opportunity to create alternatives. We have 11 and a half million dollars at hand that can be used to create those alternatives. So we're, we're asking for alternatives and in fact, the state has those the resources to put towards those alternatives. The mental health supports and healing that people need, including our LGBTQ community members are not going to happen in a facility whose original intent was to have solitary confinement was to have restraint and was to have forced drugging. And we know that although that that announcement was made just yesterday to take those pieces out. Those updates haven't been updated in any facility walkthrough, and even when the when those things were included in the facility, they weren't included in the walk through itself, we attended the meeting of the DMH. And when we walk through those, those pieces were intentionally omitted to the public and to the community. So as a state again, I'm at sharing and knowing that you will have an opportunity to create new solutions. And these solutions must be led by folks with lived experiences. People who are neuro divergent people who are psychiatrically labeled, psychiatrically disabled and self identified mad folks. So we have the opportunity to move the resources to community care solutions and not continue trauma. So we had out in the open call the house health care committee and Vermont legislators, not to fund this expensive and effective trauma producing incarcerated incarceration facility like the middle sex replacement, and instead direct funding towards peer respite community supports and long term housing. Thank you all so much. Thank you very much for bringing your voice to the table today. Thank you, I think we have one more witness who we asked to have moved to today, and I believe is still available and that's Devin green from the Vermont Association of hospitals and healthcare systems. And Devin, you have the floor. So Devin green Vermont Association of hospitals and health care systems and health systems, rather. I agree 100% that more resources need to go throughout the care continuum. I would say the way that this has been presented is as a zero sum game. And why it's being presented that way because usually that is the case in a budget year you have a small part of money that can only go so far. But I think we're in a really unique place at this moment in time to rethink our mental health system, because we have a lot of federal funding coming our way. So the latest COVID-19 relief package. These are national numbers not Vermont numbers but there is 1.5 billion towards community mental health services block grant. There's 50 million for funding community based behavioral health needs that are worsened by COVID-19. 420 million for certified community behavioral health clinics and I use behavioral health clinics and quotes because that is what is in the federal legislation. So, I do want to stress that right now the entire continuum needs resources, but that we should not peg one project against another in this case, that we have funding from the federal government coming specifically to our community health and I would also say that one project in particular that we support is an alternative to emergency departments in previous years advocates have not supported that project necessarily I would say our ED directors would love to reengage in that conversation and talk more about what we could do there because I think I think if there's one thing we can all agree on it's that emergency departments are not a great place for individuals to be when they're in a mental health crisis. And I will say that what I'll say next is just that I my understanding is that this secure residential facility is for individuals who have not been accepted by community services. So when all other community services have said no, that is when these individuals go to the residential facility. It's a small group of individuals, it is people who are no longer appropriate for being in a hospital which is a restrictive setting. And so this is placement to transition them out of the hospital back into the community. I, because this is a setting for folks who are not accepted by community other community services. I would ask that there be some kind of guarantee in place that folks who are ready to be discharged must be accepted by the community if this residential facility is not going to happen. As we have seen in the past that this small number of people can be in the hospital for a very long time when there's no sort of step down option for them to go to a couple years ago there was an inpatient psychiatric barrier days in the process, which found that over two and a half years, 45 patients stayed 981 days longer in the hospital than was necessary due to delays for placement in a supervised living facility. So we need to make sure that there is a step down option. And I've heard the answer from other folks testifying that it should be in the community. And I agree that we should have more step down options in the community for folks who are less serious and not at the level where the community resources are not accepting them. We also need an option for when community resources are not accepting the small group of patients. And we are continuing to see delays in the emergency department. It's still a problem. It's really interesting during COVID when folks were told that they should not go to hospitals to preserve resources and also people didn't want to get COVID. There was a real drop in the amount of visits to the emergency department. We had almost 1500 fewer visits in the emergency department this year. But the wait was the same. The amount of wait time, which again we can measure in days. It's an average of a day or two, which is not right. It's supposed to be about four hours. But that wait is still the same. And that wait is really dangerous to those patients. At this point, a lot of our EDs are realizing that it is not the condition necessarily that results in violence, but the long wait that anyone who waits in emergency department for days at a time will likely, you know, be in a situation where the patient will deteriorate. So we, again, we agree 100% that there needs to be more resources going into the communities. We think that that is going to be a possibility with the latest infusion of federal funding and we'd love to be in on that process to improve the resources for community services. We don't want this to be a zero sum game. We want the whole continuum to be to be funded because we see that even a small group of individuals.  And they will, they will add up to those 983 days where we could serve so many more people in the hospital during that time. So I would just say, you know, I think healthcare is going in this direction in general where we want to do more community, you know, we want to emphasize exercise diet that sort of thing we want to prevent the heart attack we want to prevent someone from breaking their heart. Just one moment honey. Okay, just one minute. Thank you honey. We want to prevent injury from happening and that includes psychological injury as well but when it does happen we need the resources to be there so we need the cath lab for the heart attack patient we need a rehab facility for someone who's broken their hip and we need the secure residential facility for the small group of people who need the intensive treatment. Thank you. Thank you. Are there.  I see it now. Representative Donahue. Yeah, a couple of different pieces. I've read the barrier day analysis a number of times very closely and I just think you might want to clarify it didn't say secure residential. It was a wide range everything from, for instance, supported residential in the community like the pathways program, nursing home placements which continue to be a huge struggle. And in fact it didn't I don't believe it identified in any spot, the specific secure residential program it was all sorts of supportive residential. But so those 900 days is, I think a bit. Am I right in my recollection of the report. In fact it's supervised living facility. That's right but I will say that currently. The current secure residential facility is at 95 to 100% capacity and I'll also say that with the middle sex secure residential facility. I think that folks typically had a hospital stay of 300 days as compared to other level one patients who need intensive care which is typically 100 days. So these are patients who need significant hospitalization and and would need a step down facility to avoid further significant hospitalization. I actually had a very specific question because of the commissioners announcement yesterday about emergency and voluntary procedures, the position paper that I think the hospital association put out earlier, and the emergency directors was very specific about the need for a facility that was needed for emergency and voluntary procedures because otherwise these people were going to remain stuck in the hospital. So there's a little bit of a dichotomy now in still wanting to expand beds. But is there even a need for those beds if they cannot provide the need that the hospital association believed was in a way that was necessary to be able to have those people move out. I'm specifically asking what what is the position has your position changed or evolved on the need for emergency and voluntary procedures for this plan to work or for these beds to be of use. I are our thought process with the emergency and voluntary procedure is that sometimes it unnecessarily lands people back into the hospital system so there is a person who may and going along fine and have a bad day and may need a brief intervention to get back on track. And they could and if they receive that brief intervention they would remain in the secure residential facility, instead of being re hospitalized and getting back into the system so that was our thought process. And I think that for the emergency and voluntary procedure I think the issue still remains that the actual placement need continues to be there and I don't think that taking away the emergency and voluntary procedures will collapse the whole concept of the need for the secure residential because we still need that placement. The emergency room delays. I think that the up to date DMH data continues to only have involuntary patients and you folks have the key to the voluntary patients but that's like a year old if it's possible to get more up to date. And also, it have you found a way to divide the waiting times between those people who in fact are discharged home from the emergency department, like with any kind of thing that somebody comes to the emergency department versus those who end up in the inpatient in other words, who's waiting for inpatient care, because there isn't an inpatient bed versus who's waiting because they're still trying to connect with the family support system and they can't leave the emergency room yet. I really wish we had Emma Harrigan my colleague here because she does the data analysis. My understanding is, we have not been able to differentiate, we can differentiate between inpatient and outpatient but part of the issue is that the hospitals who you go to a hospital that doesn't have an inpatient unit. They're discharged to a different hospital with an inpatient unit. That is a discharge out of the hospital. And I believe we have some ways to estimate that but I would have to get back to you and ask Emma about that. So the data we have now we don't, when we see that data and get those reports we don't know what wait times reflect people who are waiting to go home versus waiting for a bed because there isn't a bed available. Let me get back to you on that. Okay. Another one follow up to your federal influx of money question. Have you heard something different that that that's available as an ongoing operating cost, because I don't think the construction is the issue it's it's operating over time and you know the costs of operating this over time versus community programs with this is your is what you're hearing that some of this would be long term operating costs money. What I heard about the $1.5 billion for community mental health services was it needs to be expended by 2025, which is not long term, but it is also not one time. Can I say that I'm, I think we're all very interested in understanding what the, what the parameters of the new federal money might provide as opportunities and it's very important for us to understand what those what they are. And I think it's going to be three years while they sound large if they're for the whole country they're not very large, frankly, and, but on the other hand, we do know that Vermont is about to receive a disproportionately large influx of federal dollars and I think we should We have asked and we're going to formally asked with a letter from myself and Senator Lyons, the federal group policy group to re engage, which had been engaging previously to help us make sure we understood how the federal policy changes interface with Vermont current policy and statutes. It's imperative that we that we understand this as we make important and really pivotal decisions, particularly about this system of care, as well as the whole health care system generally where there's a lot of also changes pending. So we're in the midst of some fast flowing streams, which we need to understand as we try to make some decisions. So we'll look to everyone in the various parts of the health care system to help us become knowledgeable about that and Devin I would ask you and welcome you as well as others. We are going to engage with our fellow federal delegation through all the different points of access that we have, but we, we all need to in a relatively rapid way have some sense of what what possibilities may exist and of course our appropriations committees are going to be involved in that as well. Thank you, Devin and I want to say again express my appreciation for your flexibility from yet was that yesterday. That was yesterday. It seemed like it was days ago but yet from yesterday, your flexibility and joining us again today. And quite honestly, committee members have been asking what are the, what's the timeframe and coming to closure on this and I'm in conversation with the chair of our institutions committee, who of course are putting together the capital bill. We're in the midst of trying to make other significant decisions, and we will be doing our best to try to find a way to balance. And so, carefully, all of what we've been hearing, and we've heard from others both in terms of letters and other communications to us. This I think this is an important, this is an important decision point. And I think we're going to need to hear from each other as a committee, as committee members as to what we think might make best sense how we take next steps, and how we work with both the department, as well as our community partners in trying to make sure that Vermonters have access to the kind of assistance and care that they're looking for. I have another commitment sharply at 430 and so I'm going to turn to represent Barrows and I think that's what we're going to need to do at this point in terms of questions. I would really love to find out the difference in the success rate between the locked versus unlocked facilities. Do you think if I if I write to Commissioner squirrel she might be able to. I think the information you're looking for but that would be the appropriate place to direct your question I think to Commissioner squirrel. And I'm happy to have you do that on behalf of our committee. Okay, thank you. Great. And I will share if I hear back on the forensic information I've been requesting multiple times so. So let let me. So in the interest of moving us forward on a number of issues. We have read draft of some changing. I'm switching gears here. So just people are aware. The number of us have been working to hear what we heard from witnesses around each to 10 the health equity slash health disparities bill. We have some of us have worked with Katie Mclin, who is the lead drafts person on each to 10. My hope is that a draft, a redraft of to 10 based on a lot of what we've heard. Will be available to send out to committee members, perhaps even later this evening. Can't promise that early tomorrow morning if not. And that's that's intended to put something on the table for us to use as a point of discussion as the committee. Read it with that I in mind. Read it with what you've heard in mind. And as I, as we, as I've done in the past, I, my practice or my practice has been to try to put something on the table that allows us to move forward with discussion. Again, I find it profitable to do that from a document if possible, rather than having us all try to craft a new bill from start to finish. So this is a, this is a proposal based on what we've heard. I think you'll find it familiar in many regards take a look at it. My hope is that we may turn to that for committee discussion tomorrow afternoon after the floor. That's my hope at this point, and that we reserved a great deal of time on Friday. We were still under expectation and pressure to bring closure. We'll see if that's possible. I'm in communication with leadership about what those pressures are. So again, that's, that's my update on that. To response to earlier questions about where we are and the pressures on that tomorrow morning we are going to be hearing further information on another issue that was a high priority for this committee and that was possible expansion of Dr. And we'll see if there's something that is possible for us to do in the term timeframe we have, but we'll be hearing from the department of health access, the office of the health care advocate tomorrow morning. And then I believe we'll bring closure to h 104 tomorrow morning as well where I think we've actually, we haven't seen all of us haven't seen all the language but I think there was a pretty clear committee consensus that we were going to draft that bill and represent Peterson had expressed initially expressed interest in reporting that bill and then as we were getting into it we all could see the expression on his face and others like oh my, but I think once we reached closure. I think it may have become more possible to consider again and I have approached him to see if he would, and he has agreed to the possibility of taking that bill to the floor on behalf of our committee. We'll see where we are tomorrow morning and are you're not tied to something until we have a chance to walk through it, and we'll all work together. If you do that to support you on the floor. So, with that, I think I need to run. And I think that brings us to close your.


It's key and a different present All right this week ladies from maximum integrated what is the NPI of this week, okay? This week's NPI is the max 2361 and you're probably wondering. What is this? Well, it's this little chip That is a boost converter and it's a specific kind of boost converter Well, what kind and love to tell you, but you know what date is today? No It's Earth Day. All right. It's a day today. This is this is an eco-friendly I feel like we can be a little better to earth on Earth Day I think so too and one of the ways we can be good to the earth is by using the sun That's right. Our best friend Mr. Sun Which is the source of all life on earth can also be used to power electronic projects and sensors and you can do that Using solar panels and so this is some this is a nice big solar panel cells that we've got in the shop And we also stock a solar charger kit. We actually have a two different ones and the solar charger kits that we've got They're specifically for larger panels I can see like physically quite large panels that would go on like a backpack or like a box or you know You see these outside. They they power you know air quality sensors and stuff on the street and This boost converter the max 202 036 1 2 0 261 is a specific type of boost converter that is designed for use with very small Solar panels to charge up a small lipo battery or a super capacitor And why do you need a special boost converter? Well, I love showing this curve of solar cell Information so this is one cell so a single cell has an open Voltage like if there's if there is if it's in the sun and there's no current being drawn from it It's about like 0.6 or 0.7 volts So if you start from the right of this graph and you Move up you'll see that as you draw As you draw more and more current The voltage like you know you quickly go up you can quickly as you start drawing current the voltage The current goes up the voltage moves to the left It goes down down down and then where you see that kind of like Line that kind of is going through all the curves That's the max PowerPoint because if you draw too much current from a solar cell What happens is the voltage collapses it goes you can see how flat it is the top It goes very quickly from about 0.5 volts to 0.43 volts And then you draw even a little bit more current and like boom you're at zero volts So you have to be very very careful about how much current you draw from a solar cell Because you want to be where that like that black line that's cutting through all of the curve The rainbow curves is that's your max PowerPoint.  So right? It's very very sensitive and it isn't a fixed Voltage it depends and the fixed current it depends on how much sunlight there is on a very bright day It's gonna be that red curve on a cloudy day It's gonna be like that light blue curve in the middle, right? It depends on how much current you can draw So this boost converter and you can see on the left top left corner You can see there's a little like a diode thing with Ways coming into it. It's the inverse of an LED. It's it's a solar cell So you can connect a couple solar cells together and it's a very small chip It's very simple, but it's very effective it monitors the voltage and monitors the temperature You can program it over I squared C to give it Some details about how much max current and what the output voltage you want the boost converter to be And it will give you that output voltage and will also even wake up your circuit when it's You know gotten to a certain charge rates. I don't that'll keep your circuit from waking up Unexpectedly like before that the battery is fully charged You want to wait till the battery is fully charged and then you want your sensor to wake up and then maybe send You know blue just the energy data or Laura or cellular Wi-Fi And it's pretty efficient it does a really good job you can check it out They've got a lot of specifications for all the different, you know Boost peak currents which you can configure because you know you want to make sure that you don't overcharge your little battery as well It's just it's a delicate game right you want to get as much current out of the solar panel But you don't want to overwhelm your battery they make a really great eval board for this which I do recommend I'll show showed on the overhead later since I want to show in the very middle is the tiny little chip and And on the top right there is actually the solar cell so the solar cell here is is it looks a little bit like an OLED It's quite small to single looks like a single cell The eval board comes with like an FT 232 type dungley thing you plug it in and you can configure it I do recommend the eval boards because this chip is so small and you'll want to really configure it and play with it Before you decide on what kind of battery or super capacitor you go with It also has this cool mode with after you've set, you know use like the GUI to set the Specifications for what you want your boost converter to do Then you can go back and look at the registers to see what register values you programmed in which is like really smart because obviously Once you got it to where you want then you want to dump that data into your microcontroller To program it in and I want to mention actually usually the max PowerPoint stuff is handled by a microcontroller But when you're dealing with such small cells you don't have enough current to drive a microcontroller It'll use all of your power budget. So this is why you want the charger itself to do the max PowerPoint calculations for you Only thing about it that is you just got to watch out for I mean if you're if you're designed this into a product I'm sure you can deal with it, but it is a point four millimeter pitch BGA So personally that's you know for me I would have to go with like a four-layer board and you have to go with like very small vias Because point four millimeter pitch is small, but it's designed for wearables It's designed for very very small devices that have like micro Solar cells in them to let them charge and then perform sensor, you know readings and then transmit that data So it's small. It doesn't have a lot of pains It doesn't have even that much configuration required, which I really like they kept it simple and very straightforward It it's small. It's like it's a 1.6 by 1.2 millimeters. It's like a speck of dust You can get this on did you key? Mm-hmm. That's why we're doing Ion MPI. That's right. And the show Yeah Short real is there and the product number is there and every single week we do this We do also have video that ladies get a narrate. Yes, it's sped up twice as fast Okay I got something cool about that the reason I picked this video is check what they have is the radio on that dev board Does that look familiar? It does it does. That's our Laura breakouts. They use they're using one of our Laura breakouts So they just I like this video. We sped it up, but it basically just shows everything on the eval board It shows the super capacitor It shows this is that inductor because it is a boost converter So it's you do need one inductor, but it's pretty small It can be incredibly efficient and of course we're going at very very low voltages and very very low currents They also have a nice little animation video here Telling you it's a harvester. It's meant to be shaded and lit and it's it'll it'll turn on whenever there's enough Voltage and current for it to start charging That's why a super capacitor is really good in this case because it'll it can charge up very quickly It's not as sensitive as a lipo, but you know, of course you can use a lipo as well. And that's this week's IMPI