ORDER THIS HEARING OF THE SENATE
COMMITTEE ON HEALTH.
AND WELL WELCOME EVERYONE HERE --
WE HAVE EIGHT ITEMS ON OUR
AGENDA WE DO HAVE FOR ITEMS
HONOR CONSENT CALENDAR DOES OUR
ITEM NUMBER ONE AB FOR FIFTY
THREE ITEM NUMBER THREE EIGHTY
SIX NINETEEN ITEM FOR EIGHTY
SEVEN EIGHTY ONE AND ITEM NUMBER
FIVE AB EIGHT FIFTY ONE SO THOSE.
ARE CURRENTLY ON THE CONSENT
CALENDAR -- AND BASICALLY WE
WILL AS A REMINDER OF OUR RULES
HERE -- WE WILL TAKE FIRST THAT
WE WERE HERE TEST.
SUPPORT TESTIMONY AFTER
PRESENTATION BY THE AUTHOR -- AT
TWO SIX MINUTES -- ON ONE SIDE
THEN WE WILL -- TAKE ANY -- ME
TO USE -- BASICALLY OTHER
ARSACES THE WISH TO DECLARE
THEIR SUPPORT AND THEN WE'LL
TAKE THE OPPOSITION AGAIN MAXIM
OF SIX MINUTES ON THE OTHER SIDE.
AND THEN WE WILL -- TAKE --
ADDITION AT ADDITIONAL PEOPLE IN
OPPOSITION AND MOVE FROM THERE.
OKAY SO WITH THAT.
AND IT IS COLD HERE OKAY AND SO
WITH THAT.
IN THE ABSENCE OF A QUORUM WILL
GO AHEAD AND START AS A SUB
COMMITTEE AND I WOULD LIKE TO
NOTE THAT US ASSEMBLY MEMBER
MAIENSCHEIN IS HERE AND SO WILL
LET'S.
MUCH COME UP HERE SO WE'LL START
WITH ITEM NUMBER.
TWO EIGHTY FIVE SIXTY FIVE
WELCOME THANK YOU I'VE MISTER
CHAIR AND MEMBERS AND IF I MAY
BEFORE YOU BEGIN I WANT TO THANK
YOU FOR ALWAYS BEING VERY PROMPT.
HEALTH COMMITTEE HEARINGS YOU
BACK BACK TO THE TIME WE WERE
TOGETHER THE ASSEMBLY GOING BACK
TO THE OLD DAYS STRAIGHT
ACTUALLY ASK YOU ALRIGHT I WILL
WELCOME.
YOU BET IT'S GOOD TO BE HERE
MISTER.
BEFORE I BEGIN I WILL BE
ACCEPTING THE AMENDMENTS
PROPOSED BY THE COMMITTEE.
THE SHORTAGE OF PSYCHIATRISTS IN
THE UNITED STATES HAS REACHED
CRISIS LEVELS AND CALIFORNIA'S
SUFFERING AS A RESULT THE NOTCH
NATIONAL COUNCIL FOR BEHAVE
ORIEL HEALTH.
IN ITS TWENTY SEVENTEEN REPORT
PROJECTED DEMAND FOR PSYCHIATRY
WOULD OUTSTRIP SERVICES BY 25%
IN.
TWENTY TWENTY FIVE AS IT NOW
STANDS 55% OF COUNTIES IN THE U.
S. HAVE NO PSYCHIATRIST AND 77%
HAVE A SEVERE SHORTAGE.
THE SHORTAGE IS CREATE A
CRITICAL WEAKNESSES IN OUR
PUBLIC MENTAL HEALTH CARE
DELIVERY SYSTEM THAT COUNTIES
ARE STRUGGLING TO PATCH.
BY EXPANDING THE ROLES OF OTHER
CATEGORIES OF WORKERS SUCH AS
PHYSICIAN ASSISTANTS NURSE
PRACTITIONERS IMPAIR PROVIDERS.
HOWEVER A LASTING SOLUTION
REQUIRES A MORE SUBSTANTIVE
FACTS THAT REVITALIZES THE FIELD
OF PSYCHIATRY AND MUST INCLUDE
AN INCENTIVE TO SECURE PROMISING
STUDENTS INTO CAREERS AND
COMMUNITY PSYCHIATRY.
ENSURING OUR MOST VULNERABLE
RESIDENTS HAVE ACCESS TO QUALITY
PSYCHIATRIC CARE.
AB FIVE SIXTY FIVE ADDRESSES THE
PSYCHIATRIC SHORTAGE BY TACKLING
THE HEAVY BURDEN OF DEBT SO MANY
STUDENTS SHOULDER AS THEY PURSUE
AN ADVANCED MEDICAL DEGREE.
IT'S NOT UNUSUAL IN CALIFORNIA
TO FIND PSYCHIATRIC RESIDENTS IN
TRAINING WITH DEBT LOADS
EXCEEDING TWO HUNDRED THOUSAND
DOLLARS.
THIS BILL WILL EXPANSIVELY
GRANTS FOR PSYCHIATRIC RESIDENTS
IN CALIFORNIA WHO COMMIT TO
WORKING IN THE PUBLIC SECTOR
WITH ME TO TESTIFY ON BEHALF OF
AB FIVE SIXTY FIVE R. ADRIAN
SHELTON.
WITH THE STEINBERG INSTITUTE AND
RANDALL HAGAR WITH THE
CALIFORNIA PSYCHIATRIC
ASSOCIATION.
THANK YOU IN THIS IS SUPPORT.
AFTERNOON ADRIAN SHELTON WITH
THE STEINBERG INSTITUTE AND WE
ARE PROUD TO CO SPONSOR ASSEMBLY
BILL.
FIVE SIX FIVE ACCORDING TO THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION THAT
RECENTLY RELEASED A
COMPREHENSIVE REPORT ABOUT OUR
HEALTH WORKFORCE 45% OF
PSYCHIATRISTS.
IN CALIFORNIA ARE OVER THE AGE
OF SIXTY WHICH MEANS OUR
WORKFORCE SHORTAGES ARE ONLY
GONNA BE EXACERBATED OVER TIME.
SO WE NEED TO BE MUCH MORE
PROACTIVE WE FEEL WITH REGARD TO
WORKFORCE DEVELOPMENT STRATEGIES.
LOWER PAYMENT PROGRAMS HELP TO
GENERATE INTEREST AND HARD TO
FILL PRACTICE SECTORS THAT ARE
VITAL TO THE PUBLIC INTEREST.
AND COMMUNITY BASED PSYCHIATRY
IS ESSENTIAL TO OUR WORK FORCE
IN OUR SYSTEM OF CARE.
WE'RE SPONSORING AB FIVE SIX
FIVE BECAUSE WE WANT TO ENSURE
THAT OUR MOST VULNERABLE
RESIDENTS HAVE ACCESS TO QUALITY
PSYCHIATRIC CARE IN THE
COMMUNITIES THIS REALLY CANNOT
BE UNDERSTATED.
THERE ARE PROGRAMS IN CALIFORNIA
THAT ARE TRAINING OUR FUTURE.
A PSYCHIATRIC WORK FORCE AND WE
CURRENTLY HAVE COMMITTEE
PSYCHIATRIST WHO ARE SERVING THE
MOST CHALLENGING POPULATIONS
THAT WE HAVE IN CALIFORNIA.
THEY'RE SERVING THE HOMELESS FOR
EXAMPLE.
IN ONE EXAMPLE IN OAKLAND A TEAM
OF DOCTORS AND SOCIAL WORKERS
VISIT HOMELESS ENCAMPMENTS AND
THEY HAND OUT BASIC NECESSITIES
LIKE CLEAN SOCKS LIKE FOOD BUT
ALSO MEDICATIONS TO TREAT.
DEPRESSION ANXIETY OR
POSTTRAUMATIC STRESS.
PEOPLE ARE ALWAYS RECEPTIVE BUT
THE TEAM COMES EVERY DAY
OFFERING HELP HOPING TO BUILD
ENOUGH TRUST OF THESE
INDIVIDUALS WILL EVENTUALLY COME
IN FOR CARE FOR THE CLINICS AND
EVENTUALLY OFF THE STREETS ALL
TOGETHER.
THESE ARE THE PSYCHIATRISTS WERE
TALKING ABOUT WHEN WE SAY THE
COMMUNITY BASED MENTAL HEALTH
SYSTEM.
AND WE BELIEVE WE NEED TO DO
EVERYTHING WE CAN TO RECRUIT AND
RETAIN THIS VALUABLE WORK FORCE
THANK YOU.
MISTER CHAIR MEMBERS OF THE
COMMITTEE RENTAL HAGER FOR THE
CALIFORNIA PSYCHIATRIC
ASSOCIATION.
MACINNES DOVE TAIL BIT ON WHAT
AGE ARE AND IT WAS SAYING YOU
KNOW THERE'S BEEN A DEVELOPMENT
IN.
A PSYCHIATRIC TRAINING IN THE
LAST FIVE OR SIX YEARS WE
ACTUALLY HAVE SPECIALTY PROGRAMS
THAT OFFER FELLOWSHIPS THAT
PROVED PRODUCE THESE DOCTORS OR
THE STREET OCTORS.
AND IF I COULD HAVE PERMISSION
TO READ JUST FOR FIVE LINES OF A
PUBLICATION THIS IS FROM A UCSF.
INTERNAL -- DOCUMENT -- LIGHTING
THE SAME -- PSYCHIATRIST
ACTUALLY WORK WITH THE LEADS TO
CHI TRYST THERE -- IT WAS A COLD
AND RAINY DAY WHEN THE DOCTOR
FOUND ALVIN ON THE STREETS OF
OAKLAND MONTHS OUT OF JAIL
OFFICE PSYCHIATRIC MEDICATIONS
AND CONSIDERING TAKING HIS OWN
LIFE.
I WAS AT MY WIT'S END I WAS
TIRED OF GETTING HIGH I WAS
TIRED OF NOT BEING ON MEDICATION
AND NOT BEING NORMAL.
AND THIS TEAM ACTUALLY MET HIM
WHERE HE LIVED WHICH IS HOMELESS
ON THE STREETS AND WAS ABLE TO
OFFER HIM THE TYPE OF SUPPORT
THAT HE NEEDED AND IT'S IT'S
IT'S TYPICAL OF THE KIND
INNOVATIONS THAT ARE COMING OUT
OF THESE PUBLIC PSYCHIATRY
FELLOWSHIP.
THAT WE WANT TO ENCOURAGE AND
WHAT AND WE WANT TO EXPAND WE
WANT THE BEST MEDICAL STUDENTS
TO THINK ABOUT PSYCHIATRY.
WE WANT TO BE THE BEST IN THE IN
THE PSYCHIATRIC TRAINING
PROGRAMS TO THINK ABOUT PUBLIC
PSYCHIATRY BECAUSE IT'S VERY
POORLY COMPENSATED AS YOU KNOW.
THESE KINDS OF LOAN REPAYMENT
PROGRAMS CAN COMPLETE A REALLY
GREAT ROLE AND AND GETTING THEM
HERE THEY NEED TO BE.
SO -- WE COMMEND THIS BILL TO
YOU AND ASK FOR YOUR SUPPORT.
THANK YOU OTHER ADDITIONAL
WITNESSES A SUPPORT NAME
WORKSTATION POSITION.
AND HOW THEY GOT THEMSELVES WITH
KAISER PERMANENTE IN SUPPORT.
TIM ADVERBS IN CALIFORNIA
CHAPTER THE AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS IN SUPPORT.
YOU.
DOUG JOHNSON COMPANY LATITUDE ON
FAMILY SERVICES AND SUPPORT IF
YOU.
THEY OFFER FROM PRODUCT PLATEN
ADVISORS REPRESENTING ON THE
CALIFORNIANS SUPPORT.
THANK YOU.
IN A SCENE OTHER WITNESSES ANY
WITNESSES IN OPPOSITION.
CATIA.
ACTUALLY WE'RE NO LONGER OPPOSED
TO BASE AND AMENDMENTS BUT RIGHT
SPENT ON BEHALF OF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS I THINK THE COMMITTEE
AND THE AUTHOR FOR THE MEMBERS
HAVE ADOPTED TODAY.
REMOVING OPPOSITIONAL BE
OFFICIALLY NEUTRAL A CARD HAD A
SUPPORT POSITION WENT TO NEUTRAL
THERE LIKE COULD GO BACK TO
SUPPORT BUT AFTER RICHARD GO
BACK TO THEM ON THAT THANK YOU.
THANK YOU.
RIGHT ANY OTHER WITNESSES IN
OPPOSITION OKAY SAYING NINE
QUESTIONS OF COMMITTEE MEMBERS --
CENTER STUFF THANK YOU MISTER
CHAIR AND THANK YOU AT SOME
KNOWN FOR BRINGING THIS FORWARD --
CERTAINLY IN THE COUNTY
RIVERSIDE IS A CHALLENGE TO FIND
PSYCHIATRISTS AND MENTAL HEALTH
SERVICES FOR OUR RESIDENTS --
BUT TO YOUR TO YOUR WITNESS --
ARE WE SEEING AN INCREASE IN THE
NUMBER OF AVAILABLE SLOTS IN
CALIFORNIA -- FOR PSYCHIATRIC
TRAINING THAT WOULD.
MEET THE GOAL OF CATCHING UP IF
YOU WILL WITH A LOT OF THE BABY
BOOMER PSYCHIATRISTS THAT ARE
GOING TO BE RETIRING IN THE NEAR
FUTURE.
THANK YOU SENATOR SOUND THERE
ARE THERE ARE PLANS AS YOU KNOW
THAT GET THE CALIFORNIA HUMAN
THE HEALTH HEALTH CARE WORKFORCE
FUTURE HEALTH CARE WORKFORCE
COMMISSION.
DOES HAVE LAID OUT A ROADMAP TO
DO THAT AND I UNDERSTAND THAT
THEY HAVE ENGAGEMENT HERE AND
LEGISLATURE AS WELL AS IN THE
GOVERNOR'S OFFICE ON LONG TERM
PLANS.
I CAN SAY THAT INCREMENTALLY
THERE HAVE BEEN SOME OF THE SOME
INNOVATIVE PROGRAMS HAVE BEEN
ESTABLISHED LIKE AND FRESNO AND
BAKERSFIELD BY SOME OF THE
UNIVERSITIES.
AND THEY'RE SMALL BUT THEY
DIDN'T MEET A CRITICAL NEED AND
SO YOU KNOW BETWEEN THOSE KINDS
OF ACTIVITIES AND THE OPERATION
OF OF THE COMMISSION AND
HOPEFULLY SOME OF FULFILLMENT OF
ITS.
ITS VISION FOR THE FUTURE WE
WILL HAVE SOME MORE TRAINING
SLOTS OF YOU KNOW THIS IS NOT
SOMETHING YOU CAN JUST WAVE A
MAGIC WAND AND HAVE -- YOU KNOW.
A SUPPLY OF PSYCHIATRISTS TO
MEET THE STATE'S DEMANDS BUT
COULD YOU JUST REFRESH MY MEMORY.
HOW MANY YEARS POST TO MEDICAL
SCHOOL -- TO GET THROUGH -- AND
GET ALL YOUR DESIGNATIONS TO BE
A BONAFIDE PSYCHIATRISTS AND
CALIFORNIA THAT IS THE DOESN'T
EVEN SAY THE TREE AND FURTHER
SPECIALIZING BUT YES TO BECOME A
BASIC PSYCHIATRISTS HOW LONG
THAT TAKES.
WELL IT IN AFTER MEDICAL SCHOOL
TAKES FOR BASIC YEARS YOU HAVE
MORE INTERNSHIP AND THREE YEARS
OF RESIDENCY OUT YOU'RE
BASICALLY DURING YOUR INTERNSHIP
YOU'RE DOING A LOT OF THAT
GROUNDWORK PREPARATION FOR YOUR
SECOND QUESTION EFFORTS DURING
THAT RESIDENCY PER YEAR WORKING
AS A SLAVE IS NOT LIKE A MAKING.
A LOT OF MONEY ABOUT TRIGGERING
A LOT IT HELLO A DEBT SO I
WOULDN'T CHARACTERIZE IT QUITE
THAT WAY YES -- I I THINK THAT
THAT IT'S IT NEEDS TO BE SAID
THAT THOSE WHO ARE GOING ON TO
BECOME PUBLIC PSYCHIATRISTS ARE
OFTEN ADDING ANOTHER TWO YEARS --
TO THOSE BASIC FOUR YEARS AND SO
THAT'S A VERY DEDICATED
INDIVIDUAL KNOWS THE PEOPLE WE
WANT OUR TRACK.
THIS IS A VERY IMPORTANT BILL --
THANK YOU FOR BEING AFFORD I'M
HAPPY TO MOVE IT AT THE PROPER
TIME.
AND BEFORE WE MOVE ON TO OTHER
QUESTIONS I SEE THAT WE HAVE A
QUORUM SO I'M GAS SECRETED
PLEASE CALL THE ROLL.
THAT STORM.
PAN HERE CAN HEAR STONE.
STONE HERE DORADO GROW.
GROWTH HERE FOR TADO.
PHOTO HERE LEYVA.
LEYVA HERE MITCHELL MITCHELL
HERE MONNING RUBIO.
HEY WE HAVE A QUORUM THANK YOU.
OTHER QUESTIONS FROM COMMITTEE
MEMBERS -- SO.
YEAH MY THANK YOU SO MUCH FOR
BRINGING THIS BILL FORWARD -- IN
TERMS OF ESTABLISHING MORE
RESIDENCY POSITIONS I UNDERSTAND
AT LEAST IN THE BUDGET PROCESS
TO WERE SOME -- COMPONENTS THERE
FOR ACTUALLY THE STATE TO
DEVELOP SOME FOR THROUGH THE
STATE HOSPITAL SYSTEM.
I THANK GOD THERE'S OTHER PIECES
AS WELL THROUGH -- IN TERMS OF
FUNDING FOR RESIDENCY PROGRAMS --
JIMMY FUNDING THAT CAME OUT PROP --
FIFTY SIX SOME OF WHICH I WILL
GO -- TO MENTAL HEALTH AS WELL --
SO WE ARE TRYING TO TAKE CARE OF
THAT PART PART OF THE PIPELINE --
AND CERTAINLY WE CAN LOOK AT
WHAT OTHER THINGS ARE GOING ON
THE FUTURE -- AS WELL SO AND I
CAN I WANT THANK YOU -- THEIR
MENTION FOR WORKING ON MY STAFF
AND TAKING THE AMENDMENTS AS
WELL AND LOOK FOR TOO MANY THAT
FORD -- IS THERE A MOTION SOME
OF OKAY IT'S RIGHT YOU DID SAY --
CENTER STONE HAS MOVED WHICH
LIKE THE CLOTHES.
OKAY THANK YOU SO THE MOTION IS --
DO PASSES AMENDED TO
APPROPRIATIONS ACEKARD PLEASE
CALL THE ROLL.
PAN HI CAN I STONE BY STONE AYE
TORONTO [inaudible]
GROW.
GROVE I HER TADO. FOR TOTAL AYE
LEYVA AYE LEYVA AYE MITCHELL AYE
MITCHELL AYE MONNING RUBIO.
A CURLY OF SIX VOTES WILL GO BUT
THE ITEM ON THE ON CALL FOR
ABSENT MEMBERS THANK YOU THANKS
MUCH.
OKAY -- ACTUALLY DO HAVE AUTHORS
TO PRESENT TO YOU TAKE AT THE
END IF THAT AS LONG AS THE OKAY
LET'S -- WE WANT I C.
SEMINARIANS ARIAN HERE ITEM
NUMBER.
SIX EIGHTY NINE NINE THREE
WELCOME [inaudible]
YOU.
THANK YOU MISTER CHAIRMAN GOOD
AFTERNOON MEMBERS.
AB NINE NINE THREE REQUIRES A
HEALTH PLAN OR AN INDIVIDUAL
INSURANCE PLAN TO PERMIT AND HIV
SPECIALIST TO BE AN ELIGIBLE
PRIMARY CARE PROVIDER.
IF THE SPECIALIST REQUEST
PRIMARY CARE PROVIDER STATUS AND
MEETS THE HEALTH CARE SERVICE
PLANS ELIGIBILITY CRITERIA.
THIS BILL IS DESIGNED TO HELP
PATIENTS SEEKING TO ACCESS THEIR
COMPREHENSIVE HEALTHCARE THROUGH
THEIR HIV SPECIALIST WHEN THEY
HAVE.
WHEN THEY ARE HAVING DIFFICULTY --
DOING SO IN A TIMELY MANNER
PATIENTS OFTEN HAVE TO GO BACK
AND FORTH BETWEEN THEIR HIV
SPECIALIST AND PRIMARY CARE
PROVIDER BECAUSE THE TREATMENT
PLAN ADOPTED AT THE BEGINNING OF
TREATMENT.
IS NO LONGER RELEVANT AS THE
DISEASE ADVANCES YOU
MANIFESTATIONS OF THE DISEASE
MATERIALIZE AND NEW APPROACHES
AND TREATMENTS ARE NEEDED.
THIS BILL IS REINTRODUCTION OF
A. B. FIFTEEN THIRTY FOUR FROM
LAST SESSION.
AND THAT BILL RECEIVED UNANIMOUS
BIPARTISAN SUPPORT AND NO NO
VOTES -- THE BILL WAS
UNFORTUNATELY VETOED BY THE
GOVERNOR WITH THE PERSPECTIVE
THAT AN HIV SPECIALIST CAN
RECEIVE A STANDING REFERRAL.
BUT THAT DOES NOT ALWAYS WORK
BEST FOR THE PATIENT HAVING A
SPECIALIST AS PCP FACILITATES
BETTER THE MORE ACCESS TO HEALTH
CARE FOR A PATIENT WITH HIV.
AND GIVEN THE SERIOUSNESS OF
THIS VIRUS ITS LONG TERM EFFECTS
I'VE DECIDED TO BRING IT FORTH
AGAIN.
WITH ME I HAVE THE SPONSOR RAN
MARTIN ON BEHALF OF AIDS
HEALTHCARE FOUNDATION.
THANK YOU WITNESSES REPORT.
THANK YOU MISTER CHAIR MEMBERS
RAND MARTIN ON BEHALF OF THE
AIDS HEALTHCARE FOUNDATION AND
WE HAVE BEEN DOWN THIS PATH
BEFORE WE'RE HERE AGIN THERE
HAS BEEN NO CHANGE TO THE BILL
SINCE -- IT WAS LAST VOTED ON
LEGISLATURE -- IN THE LAST
SESSION I'M I DO WANT TO POINT
OUT THAT THE ANALYSIS RIGHTLY
POINTS OUT THAT PLANES COULD
ALREADY DO THIS AND IN MANY
CASES WHEN YOU'RE TALKING AT THE
EXECUTIVE LEVEL OF PLANS THEY
RECOGNIZE THAT -- THE THE
ABILITY OF AN H. I. SPACE HIV
SPECIALIST TO BE A PCP IS IS
ALREADY AVAILABLE TO THEM WHAT'S
HAPPENING UNFORTUNATELY AT THE
PRACTICAL LEVEL WE'RE WE'RE
ACTUALLY GETTING REFERRALS AND
WE'RE ACTUALLY HAVING TO DEAL
WITH THE PLANS ON A DAY TO DAY
BASIS.
WE'RE GETTING DENIED OR WERE
GETTING DELAYS WHERE A PERSON
WHO NEEDS IN PARTICULAR -- A
PARTICULAR SERVICE IS HAVING TO
WAIT THIRTY OR SIXTY OR NINETY
DAYS IN ORDER TO GET THAT
BECAUSE THE PLAN IS NOT MOVING
QUICKLY ENOUGH. TO ENSURE THE
CONTINUITY OF CARE -- REMAINS --
WE BELIEVE THAT WITH THIS
CLARITY IN THE LAW -- THERE WILL
BE -- LESS CHANCE THAT THAT'S
GOING TO HAPPEN IN THE PEOPLE
WILL BE ABLE TO CONTINUE -- TO
TO RECEIVE THE SERVICES THAT
THEY NEED -- THE DEPARTMENT OF
MENTAL -- MANAGE HEALTHCARE HAS
SUGGESTED TO US IN THE PAST THAT
WE JUST USE THEIR PROCESS OF OF
SENDING COMPLAINTS UP THE UP THE
LADDER AND HAVING THEM DEAL WITH
IT -- WE HAVE TRIED THAT -- IT'S
HARD TO DO THAT ON A CASE BY
CASE BASIS WHEN YOU'RE DEALING
WITH SO MANY PATIENTS.
ON AGAIN SO WE BELIEVE THAT THE
LANGUAGE HERE IN THE STATUTE
WILL PROVIDE THE CLARITY
NECESSARY.
TO TO FIX THIS PROBLEM ON A
GOING ON A GOING FORWARD BASIS
THANK YOU.
THANK YOU ANY OTHER WITNESSES A
SUPPORT.
TAKE A BREAK -- WITH THE
NATIONAL ASSOCIATION OF SOCIAL
WORK CALIFORNIA CHAPTER IN
STRONG SUPPORT THANK YOU.
WHILE HE'S AT ALL WITH
CALIFORNIA CHRONIC CARE
COALITION IN SUPPORT THANK YOU.
RESIDENTS FROM HAVE THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS SUPPORT THANK YOU.
OKAY ANY WITNESSES IN OPPOSITION.
XENON QUESTIONS COMMITTEE
MEMBERS.
OKAY IT'S BEEN MOVED BY CENTER
STONE -- THE SO THANK YOU
SOMEWHEREIN THIS AREA AND I
CERTAINLY RECOGNIZE THAT -- AS A
PRIMARY CARE PHYSICIAN AS A
PEDIATRICIAN RECOGNIZE THAT
ACTUALLY FOR MANY CONDITIONS
THERE IS A PARTICULAR ROLE A
SOMEONE WHO ALSO IS A SPECIALIST
CAN PLAY AND IN TERMS OF HEALTH
COORDINATOR CARE AND AS ALSO
WILLING TO ACCEPT THAT ROLES A
PRIMARY CARE PHYSICIAN THEY
SHOULD.
A AND PROVIDE THE MEDICAL HOME
THAN THEY CAN THEN WE SHOULD
ALLOW THEM TO RECOGNIZE HIM FOR
THAT SO WITH THAT IT'S BEEN
MOVED -- I DO WISH TO CLOSE.
I'LL TAKE YOUR COMMENTS AS THE
CLOSE THANK YOU.
HI THANK YOU ALL RIGHT SO THE
MOTION IS TO PASS TO
APPROPRIATIONS SECTOR PLEASE
CALL THE ROLL.
PAN HI CAN I STONE STONE AYE
DORADO.
GROW.
GROVE I HER TADO. FOR TITLE I
LEYVA LEYVA AYE MITCHELL.
MITCHELL AYE MONNING RUBIO.
RUBIO I THANK YOU VERY MUCH.
OKAY THAT THOSE SEVEN VOTES WILL
HOLD IT ON OFFER ABSENT MEMBERS
THANK YOU ALL RIGHT -- CINEMA
DONAL.
WE HAVE ITEM NUMBER SEVEN AB TEN
FOURTEEN WELCOME [inaudible]
IT AGAIN.
THANK YOU MISTER CHAIR AND
COMMITTEE MEMBERS.
I AM PLEASED TO PRESENT AB.
AB TEN FOURTEEN WHICH REQUIRES
HOSPITALS AND HEALTH FACILITIES
PROVIDE A ONE HUNDRED EIGHTY
NOTED DAY NOTICE TO THE PUBLIC
PRIOR TO DOWNGRADING CHANGING.
OR CLOSING THEIR FACILITIES.
I LIKE TOTHINK THE TERRORISTS
AFTER WORKING WITH US ON AUTHORS
AMENDMENTS -- YOU ALL SHOULD
HAVE IN FRONT OF YOU THESE
AMENDMENTS EXEMPT.
THE NOTICE REQUIREMENTS -- ON
BOTH THE BOTH EXPANSION OF
SERVICES AND CLOSER DUE TO AN
EMERGENCY OR NATURAL DISASTERS
THANK YOU FOR THOSE --
HOSPITAL'S DECISION TO REDUCE OR
ELIMINATE SERVICE CREATES A
SERIOUS CHALLENGE FOR COMMUNITY.
IN MY DISTRICT JUST LAST YEAR
THE COMMUNITY HOSPITAL OF LONG
BEACH CLOSEST STORES AFTER
ABRUPTLY DIVERTING EMERGENCY
ROOM PATIENTS TO OTHER HOSPITALS.
THIS WAS DONE WITH VERY LITTLE
NOTICE TO RESIDENTS AND VERY
LITTLE TIME TO ENGAGE THE
HOSPITAL PROVIDER.
ON AN ALTERNATIVE TO CLOSURE.
AS A RESULT PATIENTS IN MY
COMMUNITY NOW EXPERIENCE LONGER
WAIT TIMES FOR SERVICES LONGER
AMBULANCE TRAVEL TIMES AND
OVERCROWDING AT OTHER HOSPITALS
AND I'LL JUST KEEP IT CIVIL WHAT
HAPPENED LONG BEACH WAS.
WE WEREN'T GIVEN ENOUGH TIME
ENOUGH NOTICE -- TO PREPARE FOR
THAT HOSPITAL CLOSURES TO FIND
ANOTHER OPERATOR FOR EXAMPLE AND
THEY TELL THE TIMELINE BEEN A
BIT LONGER.
OR EVEN FOR EMERGENCY SERVICE
PROVIDERS TO TO TO PLAN FOR THAT
CLOSER SO THEY WERE MJOR
IMPACTS ON A COUPLE DIFFERENT
FRONTS WERE STRUGGLING WITH IT
NOW.
TRYING TO RE OPEN THAT HOSPITAL
WE DO HAVE ANOTHER OPERATOR WE
BELIEVE -- IN OUR COMMUNITY FOR
THE HOSPITAL BUT AGAIN -- HAD WE
HAD A LITTLE BIT MORE TIME OF A
TIME LINE TO ADDRESS A VARIETY
OF ISSUES IT WOULD HAVE BEEN
MUCH BETTER FOR THE COMMUNITY
MUCH BETTER FOR PUBLIC HEALTH
AND ULTIMATELY.
MUCH BETTER FOR CALIFORNIA WITH
THAT MISTER CHAIR I DO HAVE
WITNESSES HERE TODAY.
THANK YOU WITNESSES SUPPORT.
MR TURN MEMBERS TAYLOR JACKSON
WITH THE CALIFORNIA NURSES
ASSOCIATION -- WE ARE THE
SPONSORS OF AB.
TEN FOURTEEN I'D ALSO LIKE TO
THINK THAT YOU'RE IN STAFF FOR
THEIR WORK ON THIS BILL AB TEN
FOURTEEN IS A COMMONSENSE
PROPOSAL WHICH WILL ALLOW
COMMUNITIES WORKERS IMPATIENCE
MORE TIME TO PREPARE FOR
CLOSURES.
AS ASSEMBLY MEMBER O'DONNELL
SAID WHEN A CLOSURES ANNOUNCED
NURSES ELECTED OFFICIALS AND
MEMBERS OF THE COMMUNITY ARE
SOMETIMES ABLE TO GALVANIZE A
CITY AND KEEP THE HOSPITAL
OPERATING.
OR FIND ANOTHER WORKABLE
SOLUTION UNFORTUNATELY SOMETIMES
WE ARE NOT ABLE TO KEEP
FACILITIES OPEN AND THEY CLOSE
LEAVING NEIGHBORHOODS AND HEALTH
CARE DESERT.
INCREASE NOTICE TIMELINES UNDER
THIS BILL MEANS BETTER OUTCOMES
FOR YOUR CITY AND MORE TIME FOR
YOUR CONSTITUENTS TO FIGURE OUT
WHERE THEY WILL RECEIVE
HEALTHCARE OR WHERE THEIR NEXT
JOB WILL BE.
HOSPITALS ARE UNIQUE CALIFORNIA
BUSINESS AND A VITAL PART OF THE
PUBLIC INTEREST WHILE SOME MAY
BE RUN BY CORPORATIONS THEY ARE
STILL IN THE BUSINESS OF PUBLIC
SERVICE.
SAVING LIVES AND PROTECTING
PATIENTS THE IN IS GRATEFUL TO
OUR THREE BIPARTISAN JOINT
AUTHORS WHO ALL HAVE EXPERIENCED
A HOSPITAL CLOSURE IN THEIR
DISTRICT AND UNDERSTAND THE
URGENCY OF THIS ISSUE.
THIS BILL IS ASKING FOR THE BARE
MINIMUM FROM HOSPITAL ADEQUATE
NOTICE WHEN THEY DECIDE TO CLOSE
NURSES I ASK FOR YOUR AYE VOTE.
MISTER CHAIR MEMBERS THERE OF
LOCKS IN THE CALIFORNIA LABOR
FEDERATION WE ARE ALSO IN
SUPPORT -- I WANTED TO KNOW THAT
IN THAT THE ANALYSIS THE
OPPOSITION RAISE THE WARN ACT.
HOSPITALS AREN'T LIKE BIG BOX OR
MANUFACTURING THIS IS AN
INSTITUTION THAT COMMUNITIES
DEPEND ON EITHER FOR DIRECT
MEDICAL SERVICES OR THE
COMMUNITY BENEFITS THAT
NONPROFIT.
HOSPITALS -- PROVIDE AND SO THIS
IS A EXTENSION OF THE DEADLINE
OF THE TIME LINE WHEN A HOSPITAL
IS GOING TO CLOSE.
IS IS CRUCIAL SO THAT THEY CAN
PREPARE FIND ANOTHER OPERATOR
AND MAKE SURE THIS RESOURCE
REMAINS IN THE COMMUNITY AND SO
WE ARE DRIVE OUT THANK YOU.
THANK YOU OTHER WITNESSES AND
SUPPORT MISTER CHAIRMAN VERS AMY
BROWN ON BEHALF OF THE CITY OF
LONG BEACH IN SUPPORT. TO MADDEN
REPRESENT THE CALIFORNIA CHAPTER
OF AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS IN SUPPORT.
THANK YOU.
ALL RIGHT BUT THIS IS AN
OPPOSITION [inaudible]
PLEASE [inaudible]
WELCOME.
CALDERON JUST CARP IN THE
CALIFORNIA HOSPITAL ASSOCIATION
WE ARE OPPOSE UNLESS AMENDED TO
THE BILL I'M GONNA TAKE THIS
BILL IN THREE PARTS THE FIRST
PART DOES DIRECTLY DEAL WITH THE
EMERGENCY ROOM SERVICES.
MANY OF THE REEMERGENCE THE
ROOMS THAT HAVE CLOSED HAVE BEEN
CLOSED WITH ALONG WITH A
HOSPITAL OVER THE LAST TEN YEARS
OR FOR FINANCIAL REASONS SO WE
HAVE A DEEP CONCERN ABOUT ADDING.
THE LENGTH OF TIME -- THE SIX
MONTH REQUIREMENT -- TO THE BILL
WHEN OUR HOSPITAL IS FAILING AND
THEY'RE WORKING O IN RED.
AND THEN TRYING TO MANAGE THAT
FOR ANOTHER THREE TO FOUR MONTHS --
IN ADDITION ONCE WE ANNOUNCED
THE CLOSURE WE ACTUALLY TRY AND
HELP OUR EMPLOYEES FIND.
NEW JOBS THEY LOOK FOR NEW JOBS
SO WE'RE DEEPLY CONCERNED ABOUT
THE REDUCED STAFFING
IMPLICATIONS FOR THE OPERATIONS
OF THE HOSPITAL.
THE OTHER TWO SECTIONS HOWEVER
HAVEN'T BEEN MASSIVE MEANT
MENTIONED FOR THE SECOND SECTION
OF THE BILL ACTUALLY ADDS THE
SIX MONTHS TO A CHANGE IN
SERVICE.
THAT MEANS THAT IF OUR HOSPITALS
NICK YOU WANTS TO REDUCE ITS
NUMBER OF BEDS BY TWO BY.
TWO AND THEN MOVE THEM TO A PICK
YOU WE WOULD HAVE TO WAIT SIX
MONTHS.
BEFORE WE CAN START THAT PROCESS.
OR IF THEY WANTED TO CLOSE THE
SERVICE -- SO THAT THEY CAN OPEN
ANOTHER WE CAN'T START THAT
PROCESS FOR SIX MONTHS.
BECAUSE WE HAVE TO NOTIFY FOR
THE CLOSURE AND THEN START THE
PROCESS OF BEGINNING THE NEW
SERVICE SO FOR US THAT.
ADDITIONAL TIME IN WHICH WE WANT
TO CHANGE A SERVICE FOR A
PATIENT OR FOR THE NEEDS OF THE
COMMUNITY COULD BE CRITICAL --
TO FOR EXAMPLE OF OUR BURN
CENTER NEEDED TO CHANGE A
DYNAMIC REDUCE IT SERVICES AND
THEN WE MAKE THAT A MED SURGE
WE'D HAVE TO WAIT FOR THAT
NOTIFICATION PERIOD.
UNDERSTANDING THE CD PAGE --
PROCESS THE WAY WE DO WE
SPONSORED A BILL LAST YEAR THAT
ALLOWS THAT REQUIRE CD PAGE TO
DO THEIR APPROVAL PROCESS AND A
HUNDRED DAYS.
BECAUSE IT WAS LONGER THAN THAT
ON AVERAGE AS MUCH AS WE LOVE
OUR CD PAGE PARTNERS WE WERE
REALLY INTRODUCED A BILL TO
FORCE THEM. TO REALLY SHORTEN
THEIR TIME FRAME SO FOR US TO
HAVE TO WAIT THE SIX MONTHS
BECAUSE WERE CLOSING A PART OF A
SERVICE AND THEN TO MANAGE THAT
NEXT CHANGE ALTHOUGH THE BILL
DOESN'T SAY WE HAVE TO WAIT FOR
AN ADDITIONAL SERVICE.
NOW WE STILL HAVE TO WAIT TO
CLOSE THE SERVICE AND USUALLY
WERE CLOSING THE SERVICE AND
REPLACING IT WITH SOMETHING ELSE.
SO FOR US THAT'S AN ADDITIONAL
SIX MONTHS ON TOP OF A THREE
MONTH -- HUNDRED DAY PERIOD --
AND THEN THE THE SORT OF CHANGE
IN SERVICE THE NEXT SECTION OF
THE BILL THE THIRD SECTION IS
REALLY THE SUPPLEMENTAL SERVICES
WHICH ARE DEFINED SET OF
SERVICES -- AND THEN YOU HAVE
ANOTHER PART OF THE BILL TO TALK
ABOUT A CHANGE IN SERVICE AND
WOULD CREATE SOME CONFUSION
AROUND WHAT WE'RE TALKING ABOUT
WHEN IT.
COMES TO HOSPITAL OPERATIONS WE
CHANGE OUR SERVICES ALL THE TIME
WE CHANGE THE TYPE OF MRI
MACHINES WE USE IN THERE FOR
THAT COULD BE A SERVICE OF THE
MRI MACHINE IS USED FOR A NEW
SERVICE OR A DIFFERENT SERVICE.
WE CHANGE THE NUMBER OF BEDS IN
MED SURGE UNITS OR IN -- PICK
USER NICK USE ARE ALL OF THE
VARIOUS PLACES IN THE HOSPITAL
SO FOR US THE CHANGE IN SERVICES
BECOMING AS WE TAKE A DEEPER
LOOK INTO THIS BILL TO WORK WITH
THE AUTHOR.
IT'S BECOMING A DEEPER SET OF
CONCERNS AND HOW IT WILL DELAY
THE PER IN OF THE SERVICES THAT
ARE NEEDED FOR THAT COMMUNITY SO.
FOR THOSE REASONS REMAIN OPPOSED.
OTHER WITNESSES IN OPPOSITION.
FACING NINE QUESTIONS MANY
MEMBERS CENTER STONE YEAH THANK
YOU -- CATHERINE IF I CAN ASK
YOU A FEW QUESTIONS -- YOU KNOW
WE WE WE THE LEGISLATURE HAS
STRUGGLED IN THE PAST FEW YEARS
OVER THE THREE FORTY B. PROGRAM
AND I CAN TELL YOU THAT.
MY DISTRICT IF THAT PROGRAM GOES
AWAY HOSPITAL CLOSE.
SO.
HOW DO YOU ENVISION THIS
LEGISLATION TO BE ENFORCED IF A
HOSPITAL CLOSES ABRUPTLY GOES
INTO BANKRUPTCY?
WHAT WHAT'S THE REMEDY
[inaudible]
I THINK.
I THINK WHAT WOULD HAPPEN IS
THAT CV PH WOULD COME IN AND
CLOSE THE HOSPITAL BECAUSE WE
DON'T HAVE STAFF TO PROVIDE THE
SERVICE WE STILL ARE A LICENSED
ENTITY THAT HAVEN'T PROVIDED A
CERTAIN LEVEL.
I WOULD HOPE THAT -- SHOULD THE
PENALTY BILL GET PASSED WERE NOT
ALSO PENALIZED ON TOP OF FIFTH --
BUT IT WOULD IT IS A FRUSTRATING
SITUATION FOR HOSPITALS WHO --
AND USUALLY WHEN THE HOSPITAL
CLOSES FOR FINANCIAL REASONS --
I THINK THE INSTANCE YOU TALKED
ABOUT WAS BECAUSE OF SEISMIC IT
WAS A DIFFERENT SET OF
CIRCUMSTANCES BUT WE'VE HAD
HOSPITALS HAVE CLOSED BECAUSE I
THINK WE THE WE'VE HAD HOSPITALS
ARE CLOSING BECAUSE THEY CAN'T
AFFORD TO STAY OPEN THEY CAN'T
PAY PAYROLL THEY CAN'T ALL OF
THOSE THINGS.
AND SO SIX MONTHS COULD
FRUSTRATE OKAY SO IT WAS.
A FINANCIAL MIGHT HAVE BEEN IT
YOU KNOW I RECOGNIZING THAT THE
COMMUTER HOUSE ALONG BEACH HAD
MARRIED REASONS SO THAT'S A
REALITY AND THEN I SO I'LL POINT
TO ANOTHER EXAMPLE THAT HAPPENED
IN MY AREA ALBEIT A DIFFERENT
COUNTY THAT WE HAD A HOSPITAL
DEAREST CALL FARBER COST BATTLE.
THAT WAS HAVING SOME FINANCIAL
DIFFICULTIES.
AND WHEN IT BECAME APPARENT THAT
THEY WERE PROBABLY NOT GONNA BE
ABLE TO STAY IN BUSINESS VERY
LONG.
ALL THEIR EMPLOYEES FLED.
AND THEY HAD NO STAFF TO TAKE
CARE OF THEIR EMERGENCY ROOM SO --
USUALLY THE THE NURSES AND
DOCTORS KNOW WHAT A HOSPITAL IS
A GOOD FISCAL HEALTH ARE NOT
GOOD FISCAL HEALTH AND IF
THERE'S A RUMOR GOING AROUND
THAT.
THE HOSPITALS GOING TO CLOSE AND
YOUR EMPLOYEES FULLY -- I'M NOT
SURE HOW YOU'RE GONNA
COMPREHENSIVELY AND EFFECTIVELY
AND SAFELY OPERATE AN EMERGENCY
ROOM AND I THINK YOU KINDA
HIGHLIGHTED THAT AS ONE OF YOUR
POINTS.
AND THEN LASTLY HAVE YOU WORK
WITH THE AUTHOR TO COME UP WITH
BABY SOME SERVICE AND EXEMPTIONS
TO TO TALK ABOUT.
AN EXAMPLE -- MY DAUGHTER JUST
HAD TWINS AND AT THE HIGHS ARE
IN -- WOODLAND HILLS.
ANDTHE HAVE A NICK -- UNIT
THERE BUT THE THE NICK YOU UNITS
IN THE AREA THAT REALLY TAKES
CARE OF THE MORE CRITICAL CASES
AND PANORAMA CITY.
SELECT -- KINDA MAYBE.
SENDING PEOPLE MORE TO PANORAMA
MAYBE DE EMPHASIZING THE
WOODLAND HILLS SO IF THEY
DECIDED THAT THEY WANTED TO TAKE
TO NICK YOU UNITS OUT OF
WOODLAND HILLS.
AND TRANSFER THEM TO WEAR THEIR
PROVIDING MORE COMPREHENSIVE
NIKKI UNITS AND AND PANORAMA
CITY ARE YOU SAYING THAT THEY
WOULD HAVE TO WAIT SIX MONTHS TO
BE ABLE TO EFFECTUATE ARE GOING
TO USE THAT EXAMPLE I THINK THE
ANSWER IS.
NOT EXACTLY FRANKLY BECAUSE THE
BILL HAS AN EXEMPTION IN THE
AMENDMENTS THAT WOULD ALLOW YOU
TO ADD SO YOU DON'T TO WAIT SIX
MONTHS TO ADD SO WOODLAND HILLS
CAN ADD. TWENTY NICK PICKING
THEIR GOING TO TAKE AWAY TO TO
ADD.
TO TWO DIFFERENT FACILITIES
RIGHT SO THEY'RE TWO DIFFERENT
LICENSES -- WOODLAND HILLS COULD
ADD ALL AT ONCE -- THE HANNAH
AND I'M SORRY IF I MISUNDERSTOOD
PAN OR THE PANORAMA CITY IS THAT
IT WOULD WHAT SO WHOEVER'S THE
WOODLAND IF THEY'RE TAKING AWAY
YES WOULD HAVE TO WAIT THE SIX
MONTHS.
BECAUSE OF THE CHANGE AND
SERVICE OR A DOWNGRADE AND
SERVICE THAT HAVE TO WAIT THE
SIX MONTHS TO TAKE THE BEDS OFF
LINE OUR CONCERN IS IF THEY
WANTED TO CONVERT THOSE TO A
PICK YOU.
THAT BOTH ARE A CHANGE THE PICK
YOU COULD BE ADDED THE NICK YOU
WOULD HAVE TO WAIT SIX MONTHS TO
TAKE THEM OFF LINE IF YOU'RE
USING THE SAME SPACE YOU'RE NOW
WAITING THE SIX MONTHS.
OKAY HAVE YOU TRIED WORKING WHEN
THE AUTHOR ON HAVE HAD JUST
CAPTIONS -- ON THE CHANGE IN
SERVICE -- THERE HAVE BEEN
DISCUSSIONS.
THEY JUST WANTED TO ADDRESS.
SAID THAT OKAY YES PLEASE.
LISTEN WE HAVE HAD CONVERSATIONS
IT'S CLEAR THAT WE NEED TO HAVE
MORE CONVERSATIONS I THINK SHE'S
BROUGHT UP SOME VERY VALID
POINTS AND I COMMIT TO WORKING
WITH WITH THE OPPOSITION. TO
ADDRESS THEIR CONCERNS ON THE
CHECK SPECIFICALLY ON THAT
CHANGE IN SERVICE.
THIS CHANGE IN SERVICE QUESTIONS --
THANK YOU JOHN I WAS THAT
SOMETIMES IT'S NOT ALWAYS A ONE
SIZE FIT ALL THERE'S ALWAYS
EXCEPTIONS IN.
I DON'T THINK YOU WANT TO GO
BACK FOR NEXT YEAR FOR THE BILLS
TO REPAIR THE BILL'S CLARA AND
ATTEND CONSEQUENCES I DON'T
THINK THAT'S WHAT YOUR ATTENTION
AS AND SO -- I APPRECIATE TO
WORK WITH THE OPPOSITE YEAH.
THANK YOU AND YOU'VE GOT
SOMETHING BRIEF SAY YES SIDE
THROUGH THE CHAIR -- TAYLOR
JACKSON FOR OF THE NURSES -- I
DID WANT TO ALSO KNOW -- A TERM
I'VE HEARD KIND OF COIN BY STAFF
IS GHOST CLOSURES SO I DON'T
WANT TO COMPLETELY NEGATE THE
SIGNIFICANCE OF CHANGES IN
SERVICES.
BECAUSE OFTEN TO GET AROUND --
HOSPITAL CLOSURES WE WILL SEE
EDIE'S ARE ICY USE OR MAJOR
DEPARTMENTS CLOSE BEFORE THE
FULL HOSPITAL CLOSURE SO I I
DON'T WANT TO YOU KNOW SAY THAT
THE AUTHOR IS NOT OPEN AND
OBVIOUSLY I JUST SPEAK FOR THE
NURSES -- BUT YOU KNOW THIS KIND
OF SMALLER CHANGES IN SERVICES
THAT WE'RE DISCUSSING IS
DEFINITELY KIND OF A REASONABLE
DISCUSSION BUT THE YOU KNOW
CUTTING SERVICES AND HALF
CLOSING ENTIRE DEPARTMENTS.
I THINK THAT FALLS MORE IN THE
KIND OF SIGNIFICANT ARENA AND
YOU KNOW OBVIOUSLY CONVERSATIONS
ARE ON GOING ABOUT WHAT THE
SCOPE OF THAT LANGUAGE WOULD
LOOK LIKE BUT I DID WANNA.
PUT THAT OUT THERE AS WELL.
ALL RIGHT THANK YOU CENTER RUBIO
YES THANK YOU.
BECAUSE I HAVE A COUPLE OF
QUESTIONS IF I MAY THINK KILL
I'M JUST A LITTLE CURIOUS ABOUT
THE HUNDRED AND EIGHTY DAYS.
WHY THE ONE EIGHTY DAYS I GUESS
I STRUGGLING TO FIND
JUSTIFICATION FOR THE ONE EIGHTY
DAYS?
YOU KNOW WHAT I SPEAKER FOR THE
I'M NOT.
WHEN I'M I CAN SPEAK IN MY
COMMUNITIES EXPERIENCE WHY ONE
HUNDRED EIGHTY DAYS WELL WHEN
HOSPITALS IN A CLOSING YOUR PLAN
FOR EMERGENCY SERVICES WHERE
THEY GOING TO TAKE THE PATIENTS
THEY SERVE?
VI PARAMEDICS AMBULANCE
SERVICES EXEDRA.
AND ALSO WHAT YOU REALLY WANT
THE BEST CASE SCENARIO IS YOU
FIND ANOTHER OPERATOR TO COME IN.
AND TAKE OVER THE HOSPITAL
THAT'S WHAT WE SOUGHT TO DO
HOMAGE TO THE TIMELINE JUST
WASN'T LONG ENOUGH.
AND US THAT THAT THAT'S WHERE WE
GET THE ONE HUNDRED EIGHTY DAYS
I MEAN I I DON'T I DON'T THINK
WE CAN ASK FOR TWO YEARS.
BUT WE'RE TRYING TO BE
REASONABLE HERE.
AT NIGHT COMPLETELY UNDERSTAND
LIKE WHAT YOU'RE SAYING ABOUT
YOU KNOW YOUR COMMUNITY CLOSING
AND HAVING TO FIND ANOTHER PLACE
BUT I GOT GUESS I'M ALSO
STRUGGLING.
THAT WE'RE NOT DEALING WITH THE
CLOSING OF A HOSPITAL THEN THIS
BILL ALSO TALKS ABOUT A CHANGE
IN SERVICE SO.
WHAT YOU JUST STATED DOESN'T
REALLY QUITE ADDRESS FOR ME WHY
THE CHANGE IN SERVICE?
IF IT'S TO GIVE YOU KNOW --
HOSPITALS ENOUGH TIME.
TO YOU KNOW TO FIND AN
ALTERNATIVE.
WHY THE CHANGE IN SERVICE I'M
ALSO STRUGGLING TO UNDERSTAND?
I'M SORRY LIKE YOU KNOW ADDING
SERVICES YEAH.
I I DON'T UNDERSTAND THE
QUESTION I'M SORRY.
WELL YOU KNOW WE'RE TALKING
ABOUT CLOSING DOWN WHAT HAPPENED
IN YOUR COMMUNITY YOU NEEDED TO
CLOSE DOWN THE HOSPITAL AND
PEOPLE ARE STRUGGLING TO FIND A
NEW HOSPITAL TO GET SERVICES.
BUT THIS IS NOT ABOUT JUST AOUT
CLOSING HOSPITAL IT ALSO TO YOU
KNOW I JUST HEARD THE DISCUSSION
ABOUT CHANGES IN SERVICE AND MY
SENATE WRESTLING JUST A CLARIFY.
THE AUTHOR HAS ACCEPTED
AMENDMENTS TO SAID YOU INCREASE
THE SERVICE YOU DON'T HAVE TO
WAIT NOW IF YOU DO.
CUT A REDUCE THE SERVICE YOU
HAVE A HUNDRED EIGHTY DAYS SUCH
VIA CLARIFIED THAT SAID.
THE THE THE AUTHOR DID ACCEPT
THAT AMENDMENT THAT IS BEFORE
YOU.
HERE TODAY SELL SELL ITS THAT
GUY'S GOING ONE DIRECTION IF YOU
DECIDE YOU WANT CUT OR REDUCE
SERVICES IT'S A HUNDRED EIGHTY
DAYS BUT IF YOU INCREASED
THERE'S NO WAIT.
BUT EVEN TEN YOU KNOW AS YOU
KNOW THEY WERE SHARING THAT
SOMETIMES BASED ON DIFFERENT
COMMUNITY NEED SOME TEARS UP
COMMITTEE MIGHT FIND THAT THERE
IS A HIGHER NEED FOR CERTAIN
SERVICE.
AGAIN EVERY COMMUNITY IS
DIFFERENT AND SO I'M JUST ALSO
WONDERING IN TERMS OF DECREASING
SERVICES MOVING LET'S SAY
RESOURCES FROM.
ONE SERVICE TO ANOTHER.
YOU KNOW IT MIGHT BE JUST
SPECIFIC TO THAT COMMUNITY SO
AGAIN.
I'M STRUGGLING TO UNDERSTAND HOW
THE TWO ARE TOGETHER IN THIS
BILL BECAUSE I UNDERSTAND YOUR
SITUATION ABOUT THE CLOSING AND
HAVING TO FIND A DIFFERENT
PROVIDER.
ON MAKING SURE THAT PATIENTS
HAVE SERVICE BUT THEN THIS ADDED.
ADDITION IS WHAT I'M CERTAINLY
ALSO TO UNDERSTAND.
THROUGH THE CHAIR I THANK YOU
SENATOR FOR THE QUESTION -- OUR
CONCERN IS ALWAYS AT THE HIGHEST
LEVEL ACCESS TO HEALTH CARE
SERVICES FOR OUR PATIENTS AS
NURSES AND WHEN YOU TALK ABOUT A
HOSPITAL CLOSURE YOU'RE TALKING
ABOUT THE COMMUNITY NOT HAVING
ACCESS TO BASIC SERVICES WHICH A
DECREASE IN SERVICES FALLS
WITHIN THAT.
AND WHAT WE PREDOMINATELY SEE IT
IS THESE GHOST CLOSURES WHERE
THEY'RE CLOSING LARGE
DEPARTMENTS ARE CUTTING
DEPARTMENTS AND HALF AND THAT
YOU KNOW DRAMATICALLY AFFECTS
COMMUNITIES ACCESS TO SERVICES
AS YOU'RE.
WELL AWARE -- YOU KNOW I THINK
AS WE'VE DISCUSSED PREVIOUSLY
WERE OPEN TO WHEN THERE'SMORE
MINUTE CHANGES ANA DEPARTMENT
WHEN THEY'RE LOOKING AT LOWERING
BY ONLY A FEW BAD.
THRESHOLD -- THAT THAT'S SOME
LANGUAGE WERE WILLING TO LOOK AT
MOVING FORWARD BUT WE FEEL THAT
LARGE SCALE CHANGES -- EVEN IF
IT IS ONLY WITHIN A COUPLE
DEPARTMENTS IS JUST AS IMPORTANT
TO THE COMMUNITY AS IF THEY ARE
TRYING TO CLOSE THE WHOLE
FACILITY.
SO I KNOWLEDGE AS SOMETHING I
JUST HEARD RIGHT NOW AS WELL.
WHEN YOU HAVE A HUNDRED AND
EIGHTY DAYS?
MY FEAR IN TERMS OF PROVIDING
SERVICES AND I THINK SOMEONE
EXPRESS SAID YOU KNOW WHEN
PEOPLE KNOW THAT FROM THERE
THEIR JOB IS GOING TO CLOSE
WHETHER IT'S A HOSPITAL OR
ANYTHING ELSE.
THEY START LOOKING FOR ANOTHER
JOB SO WHAT HAPPENS WITH NURSES
AND OTHER YOU KNOW PROVIDERS
DECIDE TO FIND ANOTHER JOB WHAT
HAPPENS THEN.
US SO SPEAKING FOR THE NURSES --
OUR EXPERIENCE AT HOSPITALS AS
THEY HAVE DO NOT HAVE A HARD
TIME FINDING STAFFING WHEN
THERE'S A SHORTAGE OF WORKERS.
FOR DIFFERENT REASONS THEY HAVE
ACCESS TO ALL SORTS OF DIFFERENT
AGENCIES AND GROUPS THAT THEY
USE ALSO THE PREDOMINATELY WHEN
HOSPITALS ARE PLANNING CLOSER IS
AN ATTRITION PLAN.
NORMALLY PUT IN PLACE THEY MAKE
A PLAN FOR WE ARE GOING TO LOSE
SOME PERCENTAGE OF PEOPLE --
WHICH IS NOT NECESSARILY A BAD
THING YOU DON'T WANT ALL THE
WORKERS TRAPPED WITHOUT A JOB --
WHICH IS WHAT HAPPENS UNDER
CURRENT LAW WITH ONLY THE THIRTY
DAYS NOTICE IF A HOSPITAL
DOESN'T HAVE AN EMERGENCY
DEPARTMENT IT'S VERY DIFFICULT
TO FIND NEW EMPLOYMENT IN LESS
THAN THIRTY DAYS -- SO WE THINK
IT'S VIRTUOUS AND WE DON'T THINK
THE HOSPITALS WILL HAVE A HUGE
PROBLEM FINING PEOPLE IF THEY DO
DPH HAS THE AUTHORITY TO COME IN.
AND CLOSE SPECIFIC DEPARTMENTS
OR THE WHOLE FACILITY BEFORE THE
HUNDRED AND EIGHTY DAYS SO IT'S
NOT THAT HOSPITALS WILL BE.
COMPLETELY JUST YOU KNOW
OPERATING WITH NOBODY -- ON
STAFF.
BUT AND I UNDERSTAND WHAT YOU'RE
SAYING BUT AT THIS POINT YOUR
YOUR YOU'RE SAYING THAT THEY CAN
GET TEMPORARY WORKERS TO FILL
THE THE GAP BETWEEN BUT YOU KNOW
WHENEVER SOMEONE LEAVES TO THE
END OF THE ONE EIGHTY DAIS IS
THAT WHAT I'M HEARING.
WELL IF I IF I COULD MISTER
CHAIR I CAN ONLY SPEAK TO MY OWN
EXPERIENCE OF LONG BEACH AND IF
I UNDERSTAND WHAT THEY DID
CORRECTLY -- WAS THE INCENTIVIZE.
THE NURSES TO STAY ON FOR A
CERTAIN PERIOD OF TIME THERE WAS
A FINANCIAL INCENTIVE FOR THEM
TO STAY ON FOR AGAIN A
DESIGNATED PERIOD OF TIME SO THE
HOSPITAL COULD SUSTAIN
OPERATIONS.
AND WELL LET ME JUST FINISH THE
THOUGHT OKAY BECAUSE YOU KNOW
EARLIERI HEARD YOU SAY THAT YES
THAT THERE'S A DEPARTMENTS THAT
HAVE UP AND PLAY THAT THEY COULD
COME IN A FULL FILL THAT VOID
YOU KNOW BUT BUT AGAIN WE'RE
TALKING ABOUT QUALITY SERVICE.
I MEAN I HAVE TO BELIEVE THAT IF
YOU DON'T HAVE THE STAFF THAT
YOU'RE NORMALLY HAVE ON A NORMAL
BASIS AND YOU HAVE PEOPLE IN AND
OUT. TO ME THAT DIMINISHES THE
QUALITY OF SERVICE FOR FOR ANY
PATIENT.
WITH YOU KNOW IF YOU WANT TO
BRING TEMPORARY WORKERS I DON'T
THINK THAT IS FOR ME THE BEST
OPTION TO PROVIDE BETTER CARE TO
ME THAT'S DIMINISH SERVICES AND
DIMINISH CARE.
SO AGAIN I'M I'M REALLY
STRUGGLING TO UNDERSTAND HOW A
HOSPITAL THAT.
ALREADY OPERATING IN THE RED
WILL BE ABLE TO FILL THAT
DEFICIENCY IN AND AGAIN IF
NURSES ARE LEAVING A
PROFESSIONALS UP IN THE FALL
LONG TIME.
I DO BELIEVE PERSONALLY THAT
YOU'RE NOT GETTING THE BEST
PEOPLE THAT KNOW THE SYSTEM THAT
NO THE COMMUNITY THAT KNOW THE
PATIENTS. TO ME IT'S STILL
DIMINISH QUALITY OF CARE I'LL
BUT THAT'S JUST MY PERSONAL DIED
IN WHEN I'M STRUGGLING WITH BUT
I ALSO RESEARCHED YOU KNOW OTHER
STATES THAT HAVE.
YOU KNOW THIS PARTICULAR ISSUE
AND THEIR SIX STATES THAT HAVE --
I BELIEVE IT SIXTY DAYS NOTICE.
SIX STATES IN THE UNITED STATES
AND ONLY TO HAVE NINETY DAYS
WERE ONE OF THEM ALREADY SO
WE'RE ONE OF THE MOST AGGRESSIVE
IN TERMS OF NOTIFICATION.
AND WE WOULD BE THE FIRST ONES
TO GO A HUNDRED AND EIGHTY DAYS
SO I JUST.
AGAIN THE ONE EIGHTY DAYS TO ME
IS A LITTLE ARBITRARY I'M TRYING.
TO YOU KNOW WHEN WE THINK OF THE
OTHER SIX STATES AND ALREADY
CALIFORNIA BEING THE MOST
AGGRESSIVE I'M TRYING TO
UNDERSTAND IF ONE HUNDRED AND
EIGHTY DAYS IS.
I I'M JUST NOT COMFORTABLE WITH
THAT NUMBER AND I'M STILL NOT.
HEARING.
HOW THAT JUSTIFIES THE ONE
EIGHTY DAYS BUT FOR ANYBODY I
CAN SPEAK MORE SPECIFICALLY TO
THE?
YEAH GO AHEAD.
THROUGH THE CHAIR -- I I CAN'T
SPEAK MORE SPECIFICALLY TO THE
OTHER STATES OTHER THAN THIS
WOULD BE -- A PERIOD OF TIME TO
YOUR POINT WHERE -- WE COULD
BRING IN TEMPORARY WORKERS BUT
THOSE COMING TO A A PREMIUM AND
YOU ARE CORRECT WE USUALLY --
WORK HARD TO RETAIN TO THE
ASSEMBLY MEMBERS POINT WE WE
WILL PAY MORE TO RETAIN THEM BUT
THEN AGAIN AS WERE MANAGING THE
FINANCIAL HEALTH OF THE HOSPITAL
AND MAYBE WITH DECIDING TO CLOSE
THE DEPARTMENT BECAUSE OF THE
FINANCIAL DEPARTMENT OF THE
HOSPITAL.
CLOSE A HALF OF THE DEPARTMENT
OR CLOSE I'M A PART OF A UNITS --
WE ARE NOW TO KEEP THE RETENTION
LEVEL WERE NOW PAYING A PREMIUM.
SO WE'RE NOW PAYING EVEN MORE
WHILE WE'RE TRYING TO MANAGE THE
FINANCIAL HEALTH OF THE HOSPITAL
SO ARE DIFFICULTY IS THE THE
POSITION IT PUTS US AND BOTH
FORMER TRYING TO MANAGE PATIENT
CARE.
OUR PATIENTS IN THE COMMUNITY I
MANAGE WHAT THEY NEED FIGURE OUT
DO WE NEED A BIGGER -- PICK YOU
AND SO WE HAVE TO TAKE OUT HALF
THE NICK YOU DO WE NEED A BIGGER
MED SURGE WE NEED MORE CARDIAC
SERVICES WAITING THAT SIX MONTHS
FOR THE SPACE REQUIRED.
CLOSING THE SERVICE AND THE
SPACE REQUIRED WHETHER IT'S
DOWNGRADING A SERVICE OR NOT --
PAYING THE A PREMIUM BECAUSE OF
NURSES ARE NOW WE'RE EQUALLY
INVESTED IN FIGURING OUT HOW TO
GET THEM THE NEXT JOB SO WE MAY
PUT TEM IN A DIFFERENT HOSPITAL
ARE DIFFERENT PART OF THE
HOSPITAL SO THAT THEY CAN LOOK
FORWARD TO FIVE MORE YEARS OR
TEN MORE YEARS.
OR TWENTY MORE YEARS OF
EMPLOYMENT AS OPPOSED TO THE
FOUR MONTHS THERE WERE NOT
PAYING A PREMIUM FOR TEMPORARY
WORKERS WHICH IS FRUSTRATING THE
PHYSICAL -- HEALTH OF THE
HOSPITAL'S WELL SO KILL I HAVE
MORE QUESTION OF ME.
AND ACTUALLY THAN WHAT WHAT
MIGHT BE HELPFUL IS IS THAT WHEN
YOU ASK QUESTIONS I'M GONNA
ASSUME IS DIRECTED TO THE AUTHOR
UNLESS YOU WANT TO SPECIFY WHICH
WITNESS WHICH ANSWER ARE YOU CAN
SEE ALL THE WITNESSES TO ANSWER
THE QUESTION.
YES -- YES OF YOU AND I WAS
LOOKING AT ME BUT THE MEMBERS OF
THE ASK A QUESTION ACTUALLY GET
THE QUESTIONS ANSWERED THE WAY
THEY YOU KNOW WHAT THEIR SEAT TO
GET THE ANSWERS THEY'RE DEAD THE
ANSWERS TO THE QUESTIONS OR
SEEKING SELF YOU WANT.
SO BASICALLY I WHAT IF IF YOU
WANT DIRECT A QUESTION TO
PARTICULAR PERSON THAT HELPS ME
I'D TRY TO GUESS WHO YOU WANT
REALLY WANNA HEAR FROM OKAY
SOCIOLOGISTS OF THE LAST WANTED
TO THE AUTHOR.
AND I KNOW THAT THERE'S BEEN AN
EXEMPTION FOR EMERGENCIES SO FOR
EXAMPLE YOU KNOW THE PARADISE
FIRE THAT BURNED DOWN A HOSPITAL
THERE'S EXEMPTIONS AND AND YOU
KNOW I APPRECIATE THAT AMENDMENT.
BY LET ME TAKE FOR EXAMPLE --
LET'S SAY THE WOLSELEY FIRE YOU
KNOW MALIBU THAT THERE IS A FIRE
AND YOU KNOW THAT WAS THE
EMERGENCY A BRING DOWN AT THAT.
TIME.
BUT WHAT IF MONTHS LATER LET'S
SAY A YEAR LATER AND WE SEE NOW
WITH THE NINE ELEVEN TRAGEDY
THAT.
YEARS LATER IS MONTHS LATER
PEOPLE STARTED SUFFERING WITH
DIFFERENT TYPES OF ELEMENT.
OF PARTICULAR RESPIRATORY ISSUES
ASK MAMA SO WHAT IF A YEAR FROM
NOW ALL OF SEND DATA RICE'S FROM
FROM THAT FIRE AND THEY'RE
HAVING TO NEED EMERGENCY
SERVICES AND CREATE MAYBE AT
DEPARTMENT HANDLES THAT.
IT'S SO YOU'RE SAYING THAT THE
OUT SERVICES THAT WOULD NOT FALL
UNDER THIS OKAY SO THAT WOULD BE
SO THEY CAN.
LEVEL OKAY SO WHAT IF.
HOSPITAL DOESN'T HAVE ENOUGH
RESOURCES AND THEY NEEDED TO
TAKE RESOURCES FROM ONE
DEPARTMENT SO THEY CAN CREATE
THIS OTHER DEPARTMENT THAT'S
GRADING NEEDED IN THAT
PARTICULAR HOSPITAL.
VISITS TAKER THAT -- AND I THINK
THAT'S WHAT WE SPOKE ABOUT
EARLIER WITH A CHANGE IN
SERVICES PROVISION COULD
POTENTIALLY USE FURTHER
REFINEMENT AND I'M QUITE OPEN.
TO HAVING THOSE DISCUSSIONS.
THE GYM.
YEAH I ALSO WANTED TO NOTE THAT
THE YOU KNOW.
THE EXISTING ONE CALIFORNIA IS
THIRTY DAYS FOR A HOSPITAL
CLOSING THAT DOES NOT HAVE AN
EMERGENCY DEPARTMENT CURRENT
LAWS NINETY DAYS FOR AN
EMERGENCY DEPARTMENT WHICH IS.
I WOULD SAY A MAJORITY OF THE
HOSPITALS HAVE AN EMERGENCY
AROUND -- AND I WOULD ALSO NOTE
THAT NEW YORK HAS NINETY DAYS
AND NEW YORK HAS A HEALTH
COMMISSIONER WHO ACTUALLY CAN
DISPROVE HOSPITAL CLOSURES WHICH
IS NOT SOMETHING WE'RE SEEKING
TO DO IN THIS BILL WE'RE NOT
SEEKING.
TO CONTROL IF A HOSPITAL INFLOWS
WERE SIMPLY SPEAKING THE NOTICE
AND I DO TAKE YOUR POINT WELL
THAT THERE ARE A LOT OF OTHER
STATES THAT ARE NOT AT THIS
LEVEL AND THIS WOULD BE FIRST IN
THE NATION LEGISLATION -- A
HUNDRED EIGHTY DAYS AS OUR
ATTEMPT TO STRIKE A BALANCE
BETWEEN.
GIVING THE COMMUNITY ENOUGH TIME
TO POTENTIALLY FIND ANOTHER
OPERATOR FIND ANOTHER SOLUTION.
AND NOT CLOSE RIGHT AND IF IT
DOES COME TO CLOSURE THE WORKERS
ABOUT ENOUGH TIME TO TRY AND
FIND OTHER EMPLOYMENT THAT IS
WHAT WE ARE SEEKING TO DO WITH
THE HUNDRED AND EIGHTY DAYS SO I
DID WANT TO JUST.
RESPOND TO THAT EARLIER COMMENT
WELL AND I'LL JUST WRAP UP BY
SAYING I MEAN I THANK YOU FOR
YOUR COMMENT BUT TO ME STILL YES
THAT'LL GIVE ENOUGH -- TIME FOR
HIM PLACE TO FIND EMPLOYMENT --
WHETHER IT'S TWENTY DAYS THIRTY
DAYS FORTY DAYS BUT TO ME I
STILL STRUGGLE WITH POTENTIALLY
HAVING A GAP IN QUALIFIED
INDIVIDUALS IN THAT HOSPITAL.
AND HAVING TO HOLD A HOSPITAL
OPEN WHEN THE RESOURCES ARE NOT
THERE SO I'M STILL.
NOT QUITE THERE BUT THINK YOU
FRENCH MY QUESTIONS.
THANK YOU CENTER GROVE.
I THINK YOU'RE RIGHT I JUST WANT
TO FOLLOW UP ON A FEW QUESTIONS
THAT MY COLLEAGUE -- ASKED SO --
I GET THE FACT THAT IF THE
FINANCE THE HOSPITALS I
FINANCIALLY HEALTHY -- PEOPLE
GONNA KNOW THAT AND THEY'RE
GOING TO FLEE AND GET OTHER JOBS --
IS THERE.
IS THERE A REQUIREMENT THAT
STAFF AND MEDICAL PROVIDERS LIKE
MAYBE THE CHAIR OR A NURSE STATE.
AND FULFILL THE OBLIGATIONS OF
THE HOSPITAL TO EXTEND THE DAY
IS THERE A REQUIREMENT IN THAT
AT ALL.
I'M SORRY DO YOU MEAN THAT THE
CHAIR OF THE DEPARTMENT -- NURSE
LEADER I'M SORRY TALKING ABOUT
ANYBODY IF YOU HAVE A HOSPITAL
THAT IS FINANCIALLY NOT STABLE
AND YOU GUYS ARE GOING TO CLOSE
AND FOR A HUNDRED AND EIGHTY
DAYS YOU HAVE TO KEEP IT OPEN
AND YOU HAVE TO MEET STAFFING
RATIOS.
AND YOU HAVE TO MEET ONE TO ONE
CARE AT NIGHT YOU HAVE TO MEET
ALL THESE REQUIREMENTS AND YOUR
STAFF IS FLEEING.
BECAUSE THEY KNOW THEY'RE GONNA
LOSE THEIR JOB AND THEY NEED TO
GO GET ANOTHER JOB BECAUSE THEY
HAVE FAMILIES AND THEY HAVE --
STUFF THEY HAVE TO TAKECARE OF
THEY CAN'T BE OUT OF A JOB I GET
THAT RIGHT SO.
IF THEY LEAVE A 50% OF YOUR
NURSES HERE THE HOSPITAL CLOSER
OR MEDICAL PROVIDERS AND THEY
LEAVE TO GO FIND CONTRACTS OR
JOBS AT OTHER HOSPITALS.
HOW DO YOU MEET STAFFING RATIOS?
HOW DO YOU?
HAVE USED TO PROVIDE CARE TO THE
COMMUNITY FOR THAT HUNDRED AND
EIGHTY DAYS.
AND IS THERE ANY REQUIREMENT
THAT REQUIRES NURSING AND PEOPLE
THAT PROVIDE THAT QUALITY CARE
TO THE COMMUNITY.
THAT THEY STAY THE LAST DAY TELL
I MEAN I'M JUST ASKING LIKE HOW
DO YOU FULFILL THE OBLIGATIONS
OF PROVIDING SERVICES THE
COMMUNITY.
WHEN YOU LOSE YOUR STAFF AND I
AM GET A STEAMER STAFFING I WITH
THE TULARE CLOSER THERE IS NO
WAY?
IN HELL I WANT TO TRY AND SAY
THAT BUT I WILL CHOOSE FROM.
STOPPING UNFORTUNATELY -- WE
WOULD USE TEMPORARY STAFFING
LIKELY IN THIS CASE -- AND THEN
I THINK AT THAT POINT WHEN WE
CAN WHEN WE CAN TALK WITH CITY
PATIENTS A WE JUST CAN'T MEET
THE STAFFING REQUIREMENTS WE
WOULD THEN ENGAGE CD PAGE AND
THAT -- CONVERSATION THEY HAVE
THE AUTHORITY TO DETERMINE
WHETHER WERE PROVIDING SAFE CARE
ANYMORE AND THEN I THINK THAT'S
THE CORRECT TERMINOLOGY ON THE
STATUE IN FRONT OF ME BUT THEY
CAN COME IN.
AND DETERMINE -- THAT THE
HOSPITAL IS UNABLE TO PROVIDE
THAT SERVICE -- ANYMORE AND THEY
THEY WOULD THEN HAVE TO DRUM AND
EARLIER THAN THE SIX MONTHS --
BUT THAT WOULD BE A CD PHP
TERMINATION THAT'S NOT A SELF
DETERMINATION OF THIS BILL WE
HAVE TO GIVE THE NOTICE.
THAT'S MY UNDERSTANDING OF THE
PROCESS SO WE WOULD I WOULD HAVE
TO BE DETERMINED THAT OUR STATE
OR CARE IS UNSAFE WHICH IS NOT
SOMETHING.
WE EVER REALLY WANT TO HAVE
HAPPEN.
NO WHEN I UNDERSTAND THAT BUT I
I DON'T SEE -- I DON'T SEE I
DON'T ON THE GROUND I KNOW WE DO
THINGS IN THIS BUILDING WHERE WE
THINK.
YOU KNOW THIS SOUNDS GOOD UP
HERE YOU KNOW AN EXAMPLE 1100%
CLEAN AIR WE ALL WANT CLEAN AIR.
BUT TO ACHIEVE ON THE GROUND
WHEN A PERSON CLEANERS ALMOST
IMPOSSIBLE ANALYSTS TO SEPARATE
SUBJECT.
SO I GET THAT WE WANT TO MAKE
SURE THAT IF HOSPITALS NOT
FINANCIALLY VIABLE.
WE WANT TO MAKE SURE NURSES HAVE
OPPORTUNITY GO TO ANOTHER
HOSPITAL A LOT OF TIMES THEY MAY
HAVE TO RELOCATE THEIR FAMILIES
THEY MAY HAVE TO MOVE.
AND THEY MAY BE THE ONLY SOLE
PROVIDER AND SO I GET THAT I
UNDERSTAND WHERE THAN THE CARD
THAT THE PART OF THE BILL THAT'S
COMING FORWARD.
WHAT DOESN'T OPERATE ON THE
GROUND IS THE REQUIREMENTS FOR
STAFFING NURSING RATIOS FOR
PROVIDING CARDIAC CARE IF YOU
HAVE A CARDIAC DEPARTMENT? FOR
PROVIDING NICK YOU AND PICK YOU
CARE IF YOU HAVE THAT ANYTHING
YOU HAVE NO NICK YOU PICK YOU
NURSES.
AND THEY'RE AVAILABLE AT AT YOU
DON'T WITH STAFFING RATIOS
BECAUSE SOMEBODY CALLS IN AND
SAYS HEY I KNOW IT'S GOING TO BE
THERE BUT I GOT A NEW JOB I HAVE
TO START TODAY.
AND YOU ALREADY CAN'T FIND
NURSES.
AND BECAUSE THEY KNOW YOU'RE
CLOSING SO THEY'RE NOT GOING TO
WORK THERE FOR YOU KNOW A
HUNDRED EIGHTY DAYS OR SIXTY
DAYS IF AND I I WOULD ASSUME.
BASED ON JUST BUSINESS CLOSURE.
OF STAFF THE EXTRA FIVE
EXPERIENCE IN THE BUSINESS WORLD.
THE CLOSER YOU GET TO THAT
HUNDRED EIGHTY DAYS A HARDER
IT'S GOING TO BE LIKE THE LAST
TWO WEEKS LAST THIRTY DAYS LAST
NINETY YOU KNOW IT'S GONNA BE
HARDER. TO FIND THOSE PEOPLE SO
I'M JUST WONDERING HOW YOU
OPERATE ON THE GROUND IN THE
REAL WORLD AS A HOSPITAL.
WHEN THERE'S NO GUARANTEE OR
ANYTHING THAT SAYS?
YOU KNOW.
LIKE THAT HERE WE ALL KNOW HE'S
A PHYSICIAN AND YOU KNOW REQUIRE
HIS ORGANIZATION IN HIS HIS TIME
TO PARTICIPATE IN THIS UNDER
CONTRACT FOR THIS LINK THAT TIME
OR NURSES. TO DO THE SAME I AM
CONCERNED ABOUT PROVIDING
QUALITY CARE.
AND AND I KNOW THAT YOU KNOW THE
CALIFORNIA APARTMENT PUBLIC
HEALTH CAN COMMAND BUT HOW MANY
PEOPLE DON'T GET SERVICE OR WHAT
HAPPENS.
HELLO THAT TAKE THAT GONNA
HAPPEN IMMEDIATELY THE CALLING
GO HEY ARE NICK YOU UNIT DOESN'T
HAVE ANY NURSES THAT ARE HERE
TODAY WHAT WE DO WITH THESE NINE
KIDS -- BABIES DO THEY SHOW UP
INSTANTLY TO FIX YOUR PROBLEM OR
I DON'T KNOW THAT AREA OF THE
LAW IS INTIMATELY AS I PROBABLY
SHOULD AT THIS MOMENT -- ONLY
BECAUSE I DON'T THINK WE HAVE AS
MANY CLOSURES -- TO PULL FROM I
DO KNOW THAT CITY PAGE AND SOME
CLOSURES HAVE CUT HAS COME IN --
AND DOWNGRADED ANY ARE FROM AN
ADVANCED LIFE SUPPORT TO BASIC
LIFE SUPPORT OR THEY'VE COMMON
AND SAID -- WE PERMIT YOU TO
SORT OF START WITH THE PROCESS
BEFORE THE NINETY DAYS IS UP
BECAUSE TO YOUR POINT IT'S
DIFFICULT TO STAFF AT THE RATIO
WE NEED TO TO WANT -- ONE TO ONE
SO WE HAVE INSTANCES WHERE
THEY'VE COME IN AND BEGUN THE
PROCESS SOONER THAN THE NINETY
DAYS -- BECAUSE THE OUT QUALITY
OF CAREIS ONE THAT -- IS IS IS
JEOPARDIZED BY THE CLOSURE
[inaudible]
SO.
I THINK THAT'S WHERE I CAN
PROBABLY OFFLINE GET YOU A MORE --
DETAILED ANSWER THAT PROCESS NOW
OKAY THANK YOU THANK YOU THINK
RIGHT SURCHARGE.
I HAVE A LOT OF QUESTIONS I MEAN
OBVIOUSLY THIS TOPIC IS
EXTREMELY IMPORTANT TO ME
IMPORTANT TO THE CENTRAL VALLEY
RURAL CALIFORNIA I WANT TO MAKE
SURE THAT HOSPITAL THAT WE WON
THE WE CREATE MORE HOSPITALS IN
THE CENTRAL VALLEY IN MY
SENATE-DISTRICT -- THAT THE
HOSPITALS THAT ARE THERE THAT
THE REMAIN OPEN AND OBVIOUSLY
THE ACCESS TO HEALTH CARE OF IT
IT JUST DEVASTATES A COMMUNITY.
ARE.
EIGHT VERY IN A VERY BAD WAY ALL
THE WAY AROUND TO HOSPITALS TO
PATIENTS.
TO THE COMMITTEE MEMBERS TO
EVERYTHING THE SERVICES ARE
PROVIDED IN THOSE COMMUNITIES
[inaudible]
AND AND THE CENTRAL VALLEY I
FEEL THAT WE'VE HAD THE MOST
AMOUNT WELL WE I KNOW THAT WE
HAVE THE MOST AMOUNT OF HOSPITAL
CLOSURES.
ACROSS THE STATE.
SO I'M JUST TRYING TO FIGURE OUT
HOW THIS BILL.
YOU KNOW WOULD HELP PREVENT THAT
IN THE FUTURE -- BUT YOU KNOW I
ALSO.
HAVE.
SOME CONCERNS -- I KNOW THAT I
WAS READING AN ARTICLE ABOUT THE
MOST ONE OF THE MOST RECENT --
HOSPITAL CLOSURES DOWN IN AT THE
CITY OF CORCORAN.
AND THEY WENT.
SO THEY RELIED THEIR SOURCE
THEIR MAIN SOURCE OF INCOME CAME
FROM THE PRESENT AND SO WHAT
CUTS.
ARE THEY WEREN'T ABLE TO PROVIDE --
SERVICES TO INMATES THEREFORE --
BABE REALIZE BASICALLY TWO THREE
MONTHS THAT HEY.
THIS THIS THIS CHANGE AT THE
STATE LEVEL GOING TO
SIGNIFICANTLY DEVASTATE THE
HOSPITAL.
WE CAN'T AFFORD TO KEEP GOING
AND SO.
THEY ENDED UP CLOSING NOW YOU
HAVE A WHOLE ENTIRE COMMUNITY
THAT'S LEFT WITHOUT ACCESS TO
EMERGENCY SERVIES.
AND SO OBVIOUSLY LIKE I WANT AS
MUCH.
ADVANCE NOTICE FOR OUR
COMMUNITIES.
BUT YOU KNOW TO KNOW AS WE CAN
PREPARE WE ALL I I THINK WE ALL
OF THE BUT NEED TO DO THAT RIGHT
BUT I GUESS I NEED TO KNOW MORE
ABOUT HOW IT WORKS AS YOU KNOW --
A COLLEAGUE FROM FROM
BAKERSFIELD MENTIONED HOW IT
WORKS ON THE GROUND BECAUSE THIS
IS AN IMPORTANT ISSUE TO ME IT'S
AN IMPORTANT ISSUE TO MY
DISTRICT.
I WANT TO MAKE SURE THE
HOSPITALS DON'T CLOSE I WANNA
MAKE SURE THAT ARE COMMITTEE
MEMBERS HAVE ACCESS TO
HEALTHCARE.
EMERGENCY SERVICES BUT I JUST
DON'T KNOW IF IF THIS ACTUALLY.
IF THIS BILL ACTUALLY KIND OF
ADDRESSES THE ISSUE THAT WE'RE
TRYING TO ADDRESS -- AND SO I'D
LIKE TO WORK WITH WITH ALL OF
YOU TO MAKE SURE THAT IT DOES
ADDRESS.
THE ISSUES -- IN MY DISTRICT
BECAUSE THIS IS SOMETHING THAT
IS EXTREMELY PART OF ME AND IT'S
EXTREMELY IMPORTANT TO THOSE OF
MY COMMUNITY.
SO IF ANY OF YOU HAVING ANY
COMMENTS ON THE CENTRAL VALLEY
HOSPITALS AND THE DIVERSITY OF
CALIFORNIA RUBIO AS OUR IF
NEEDED FOR ABSOLUTE THE AUTHORED
TO ADDRESS IF YOU WISH TO MEET
YOU AT THE YET SPECIFIC THE
CENTRAL VALLEY WE HAD A LOT OF
DISCUSSION MORE BROADLY SO.
AND AND AND AGAIN I I DON'T KNOW
THE SPECIFIC CIRCUMSTANCES
WHAT'S OCCURRED.
HISTORICALLY IN THE CENTRAL
VALLEY I CANNOT I I BRING MY
EXPERIENCE TO THE TABLE.
WHICH WAS -- IT WAS ANNOUNCED A
HOSPITALS CLOSING THEN THAT
HOSPITAL CLOSURE WAS RAPIDLY
EXPEDITED.
AND IT HAD SIGNIFICANT IMPACTS
ON THE FACT GIVEN THE FACT THAT
WE WERE LEFT WITHOUT AN
EMERGENCY ROOM.
WHERE DO YOU TAKE THOSE PATIENTS
LONGER LONGER WAIT TIMES AND
OTHER AREA HOSPITALS?
AND THE WHOLE -- FOR FOR A FIRE
DEPARTMENT NOW WHERE WHERE THEY
TAKE PATIENTS SO IT BACKS UP.
YOU KNOW THERE TIMELINE TO
RESPOND TO TWO NINE ONE ONE
CALLS SO WHAT I'M SIMPLY TRYING
TO DO HERE TODAY IS TO HAVE A
COMMUNITY MORE.
NOTICE SO THAT THEY CAN BE
PREPARED FOR WHEN A HOSPITAL
DOES CLOSE AND THAT MEANS MAYBE
FINDING ANOTHER OPERATOR THAT'S
TYPICALLY THE HOLY GRAIL.
IT DOESN'T ALWAYS HAPPEN FOR
SURE WE CAN'T GUARANTEE THAT BUT
AGAIN TO FOR COMMUNITY
ESPECIALLY ON EMERGENCY SERVICES
SIDE TO BE ABLE TO PLAN. FOR
WHEN THAT OCCURS -- CENTER ST
FAQ FROM MISTER CHAIR I'D
APPRECIATE -- SENATOR RUBIO AS
RESEARCH ON THIS AS FAR AS THE
NINETY DAYS CATHARINE THAT OTHER
STATES -- EMPLOYEE WHICH SEEMS
TO BE WORKING -- AND AND I THINK
THAT WHAT THE AUTHOR AND THE
SPONSORS -- OR TRYING TO DO IS
IS IS IS NOBLE.
AND I THINK IT PROBABLY WOULD
WORK BETTER IN LARGER
METROPOLITAN AREAS WHEN YOU HAVE
A HOSPITAL LIKE.
CEDAR SINAI HOSPITAL IN LOS
ANGELES THAT HAS THE MULTI
DISCIPLINARY APPROACH.
TO PSYCHIATRY SURGERY -- BE YOU
KNOW AIDS CARE.
THEY THEY HAVE ALL THE SERVICES
NOW I DON'T KNOW IF YOU'RE
SEEING THIS IN THE RURAL AREAS
OUTSIDE OF WHERE I'M FROM BUT IN
THE TO MACULAR VALLEY -- WE
OFTEN HOUSE HOSPITALS THAT ARE
OWNED BY THE SAME ENTITY SO AS
AN EXAMPLE WE HAVE TO MAKE IT
ABOUT A HOSPITAL WHERE FRENCH
SPRINGS HOSPITAL.
BOB THEY CATER TO ABOUT.
HALF A MILLION PEOPLE AND THE
CHEMICAL RALLY.
AND THEY HAVE FOUND AN ECONOMY
OF SCALE THAT IF YOU HAVE ONE
HOSPITAL THAT SPECIALIZES IN NYC
YOU.
AND YOU HAVE ONE HOSPITAL THAT
SPECIALIZES IN CARDIOVASCULAR
DISEASE -- THAT THAT'S BETTER
FOR THE PATIENT AND IT'S MORE
ECONOMICAL FOR A HOSPITAL THESE
VERY CHALLENGING ECONOMIC TIMES
TO DELIVER THOSE SERVICES AND
THAT ACTUALLY DID HAPPEN. TO
MAKE IT ABOUT A HOSPITAL'S A NEW
HOSPITAL'S BEEN IN OUR AREA FOR
ABOUT FIVE OR SIX YEARS.
AND THEY HAVE DECIDED THEY'RE
SPECIALIZING NOW AND
CARDIOVASCULAR HEALTH STROKE
HEART ATTACK VICTIMS AND THE DE
EMPHASIZE.
THEIR THEIR BEATNIK YOU THEY
DON'T WANT TO HAVE HAPPEN IF YOU
UNIT THERE ANYMORE THEY'VE
CLOSED DOWN IN A BOOTH AT
TORRENTIAL SPRINGS WHICH IS.
A FIFTEEN MINUTE DRIVE TWENTY
MINUTES WHAT WHAT WHAT WITH
TRAFFIC.
SO -- IN THIS PARTICULAR CASE.
THERE'S NO LOSS OF SERVICE TO
THE AREA REALLY.
AND THERE'S NO LOSS OF JOBS FOR
THE NURSES WHICH I THINK IS
PROBABLY A PRIMARY CONCERN -- AS
TO WHY YOU'RE SPONSORING THIS
BILL.
AND SO WHEN YOU HAVE THESE KIND
OF SCENARIOS WERE THE IT'S A
ZERO SUM GAME BUT THE AREAS
GETTING A BETTER SERVICE AND
PROVIDING YOU KNOW MORE
COMPREHENSIVE HEALTH CARE.
IN SPECIALIZED WAY IT SEEMS TO
ME THAT THERE'S GOTTA BE A
MODALITY TO ALLOW THAT TO HAPPEN
UNDER YOUR BILL FOR YOUR FOR
YOUR CONSIDERATION I ONE HUNDRED
IF YOUR COMMENT ON SOME OF THE
SPECIALTIES IN THE SMALLER -- A
RULER IS LIKE I REPRESENTS SOME
OF THE RURAL AREAS LIFE HOSPITAL.
YOU KNOW IT'S IT'S A TWO TWO
HOURS FROM THE QUOTE FROM FAR
FROM PALM DESERT OR PALM SPRINGS
AND THESE THESE PEOPLE HAVE
LIMITED CHOICES.
I THINK THE DIFFICULTY WITH THIS
BILL IS THE DIVERSITY OF
CALIFORNIA TO BE FRANK -- WE
HAVE SEEN IN NORTHERN CALIFORNIA
ARE HOSPITALS -- COLLABORATE AND
DO WHAT YOU JUST SAID IN
NORTHERN CALIFORNIA HOSPITALS
THAT SPECIALIZE -- IN OR SO AND
pALSO HOSPITALS SPECIALIZING
CARDIAC AND ALSO SPECIALIZE IN
STROKE WE ACTUALLY SEE THAT IN
OUR URBAN AREAS AS WELL SAN
FRANCISCO OUT A LITTLE BIT OF
THAT.
YOU'RE HAVING A STROKE YOU KIND
OF KNOW WHAT ALL SPITTLE TO GO --
TO EXCEPT TRACK -- THE
DIFFICULTY WITH THIS TO YOUR
POINT IS WELL AS IS OUR RULE
HOSPITALS STRUGGLE FINANCIALLY
IN A REAL WAY WE HAVE HOSPITALS
THAT CAN'T MAKE PAYROLL FOR
THREE MONTHS.
AND THEY ONLY HAVE RESERVES FOR
TWO MONTHS SO WHEN THEY ARE OUT
TRYING TO FIGURE OUT HOW TO GET
ENOUGH OF THAT SYSTEM -- TO HELP
THEM AFFILIATE WITH THEM OR WHAT
NOT AND NOT FROM SUCCESSFUL THEY
MAY ONLY HAVE TWO MONTHS OF
PAYROLL LEFT -- WE AND NOT I CAN
THINK OF FOUR FOUR FIVE
HOSPITALS SO.
THUS SECTIONS TO WIN THREE
RELATED TO CHANGE IN SERVICE
MAYBE A PARTICULARLY DIFFICULT
IF YOU NEED TO DOWNSIZE OR
DOWNGRADE OR TAKE A SERVICE
OFFLINE SO THAT YOU CAN KEEP
YOUR E. R. AND MED SURGE AND
SURGICAL SUITE OPEN. FOR ANOTHER
TWO MONTHS -- SO I THINK THAT
THE STRUGGLE AND AND I HEAR THE
AUTHOR WANTING TO TALK MORE
ABOUT THAT THE BILL IS THE
DIVERSE OF IT.
OUR HOSPITALS HAVE PROBABLY TEN
DIFFERENT COMMON WAYS IN WHICH
WE MANAGE OUR SERVICES ENCLOSURE.
AND I'M PROBABLY BEING THOSE ARE
BIG BUCKETS I AM I CAN PROP
THERE'S PROBABLY FIFTY DIFFERENT
WAYS OUR HOSPITALS MANAGE THEIR
OPERATIONS AND SERVICES SO.
A CENTER ALSO [inaudible]
YES -- I'M HAVING A HARD TIME
UNDERSTANDING WHY THIS IS BAD
FOR ANY COMMUNITY.
ANY PART OF THE STATE I DON'T
CARE WHERE YOU'RE AT AND I DON'T
THINK THAT'S GOOD FROM A BIG
CITY LIKE LOS ANGELES.
OR A SMALL TOWN LIKE SELMA OR
FRESNO -- WE'RE TRYING TO DEALWITH WHAT'S THE BEST THING TO DO.
IN THAT KIND OF A SITUATION.
AND IF YOU'RE A SMALL PLACE I
WOULD WANT TO HOLD ON TO THAT
HOSPITAL AS LONG AS POSSIBLE.
I WOULD WANT IT THIS. TO CLOSE
WITHIN THIRTY DAYS OR SIXTY DAYS
OR NINETY DAYS I WANTED TO STAY
OPEN.
AND IT SEEMS TO ME THE PROCESS
OF ALLOWING A LONGER TIME BEFORE
IT CLOSES BECAUSE THE LOSS OF
THAT HOSPITALS SO DEVASTATED.
ESPECIALLY IN A RURAL AREA
ESPECIALLY WELL AREN'T SO MANY
HOSPITALS.
WHY WOULD WE WANT TO THE LENGTH
OF TIME TO REALLY JUDGE ANY
VALUE WAITING GET INPUT?
AS TO ARE THERE ALTERNATIVES ARE
THERE YOU KNOW HOW DO YOU DO
THIS HOW DO YOU DO IT IN SUCH A
WAY THAT'S THE MOST RESPONSIBLE
WITH COMMUNITY INPUT SO -- IT IS
I DON'T UNDERSTAND WHY THIS
WOULD BE ANY DIFFERENT FROM A
BIG CITY TO A RURAL AREA IN FACT
IT'S EVEN MORE IMPORTANT. FOR
RURAL AREA WHERE THERE'S LESS --
ACCESS -- TO TO HOSPITALS -- TO
MAKE SURE THAT WE HAVE THE
DEEPEST MOST PROFOUND PROCESS.
AND THE POSSIBILITY EXTEND THE
POSSIBILITY THAT WE COULD
ACTUALLY.
MAYBE.
NOT CLOSE.
NOW WOULD BE THE IDEAL IT SEEMS
TO ME JUST ANNOUNCED THE CLOSURE
AND GET OUT IS NOT THE IDEAL
IT'S THE LYNC THAN IT IS TO DO
THAT SO.
IF IF YOU HAVE SPECIFIC
EXPERIENCE IN OUR SENATOR YOU
JUST EXPLAIN THE REASON FOR THE
BILL.
THAT IS THE REASON FOR BILL THIS
IS THE EXPERIENCE I HAD A LONG
WHICH IS REAL LIFE EXPERIENCE.
WE HAD WE HAD A LONGER TIME LINE
WE COULD HAVE SOUGHT ANOTHER
OPERATOR KEPT A HOSPITAL OPEN
HAD WE HAD A LONGER TIME NINE WE
COULD'VE ADJUSTED ARE MERGING Z.
SERVICES TO MAKE A MORE
APPROPRIATE. TO TO TO TO SHORTEN.
THE WAIT TO GET INTO AN
EMERGENCY ROOM SO TO ME THIS
BILL IS A NO BRAINER THIS BILL
IS ABOUT KEEPING PEOPLE HEALTHY
SAVING LIVES THIS IS A COMMON
SENSE APPROACH.
I UNDERSTAND THERE'S SOME
TECHNICAL ISSUES WE NEED TO TALK
ABOUT WE NEED TO WORK ON I'VE
COMMITTED THAT WE'VE GONE BACK
TO THOSE A COUPLE TIMES I WELL
UNDERSTAND THAT AND I'M
COMMITTED TO HAVE DISCUSSIONS
ABOUT THAT.
BUT AGAIN -- THE PURPOSE OF THIS
BILL TO SAVE LIVES AND AND AND
THAT'S WHAT IT DOES FROM MY
PERSPECTIVE.
SO I KNOW WE ABOUT TO OTHER
MEMBERS WHO HAVE QUESTIONS TO
ASK PREVIOUS THIS OF ON THE
BIGGER INDULGENCE ARE HAVE A
COUPLE QUESTIONS AND THEN WE'LL
GET. TO TO YOU THAT RIGHT OKAY
BECAUSE SO I THE ONE THING I
WANT -- TO AND I KNOW YOU SAID
THIS SO I JUST WANTED TO CLARIFY
SO WHAT WE'RE REALLY TALKING UP.
BECAUSE I KNOW WE HAD SOME
CONVERSATIONS ABOUT LIKE LITTLE
CHANGE THOUGH LANDS WE SHRINK A
UNIT BY COUPLE BEDS AND I
UNDERSTAND YOU'VE COMMITTED TO
WORKING WITH THE OPPOSITION AND
TALK ABOUT THE SCALE BUT I THINK
WHAT WE'RE CONCERNED ABOUT WE
TALK ABOUT HOSPITAL CLOSURES.
ARE LET'S SAY A HOSPITAL.
IN A RURAL COMMUNITY IS THE ONLY
PLACE WHERE DELIVERY SOUTH AND
AND THEY DECIDED I SHUT DOWN
OBGYN.
AND SO THE QUESTION THERE IS IN
THERE THE ONLY DELIVERY SITE FOR
A VERY LONG DISTANCE.
THE QUESTION IS IS THAT HOW MUCH
TIME AND I REALIZE THERE'S A
BALANCE HERE BECAUSE YOU KNOW
MAYBE THE REASON YOU'RE MAKING
IS FINANCIAL.
A BALANCE IN TERMS OF HOW MUCH
TIME DO YOU GIVE THE COMMUNITY A
CHANCE.
TO MOBILIZE THEIR RESOURCES TO
SAY WHETHER WE CAN SAVE THAT
UNIT OR FIND AN ALTERNATIVE. TO
THAT SO WE CAN KEEP THAT SERVICE
IN OUR COMMUNITY.
IS THAT WHAT THIS BILL IS ABOUT
[inaudible]
AUTHOR.
WELL LET ME FIRST LET ME JUST.
I'M VERY SENSITIVE TO THAT THE
ROLE THE CRITICAL ACCESS
HOSPITALS USE WHY DOES BELIEVE
THERE'S TWELVE THE STATE OF
CALIFORNIA ONE IS ACTUALLY IN MY
DISTRICT ON CATALINA ISLAND.
SO I DON'T WANT ANYONE TO THINK
AT ALL THAT I'M NOT -- WELL
AWARE.
OF THE ISSUES ASSOCIATED WITH
SMALL CRITICAL ROLE ACCESS
HOSPITALS OF BUT AGAIN THIS BILL
IS.
MY INTENT.
IS TO GIVE COMMUNITIES TIME TO
PLAN.
TIME TO PLAN TIME TO ACT TO
SERVE THE BEST INTERESTS OF THAT
COMMUNITY IT'S VERY SIMPLE NOW I
GET THE CHANGE IN SERVICES I
THAT'S PRETTY TECHNICAL STUFF I
DON'T KNOW THAT WE CAN WORK IT
OUT.
RIGHT NOW -- MISTER CHAIRMAN I'M
QUITE OPENING TO TO TO HAVING
THAT CONVERSATION AND I
APPRECIATE THAT I THINK WHEN
THINGS WERE GOING TO LOOK INTO
IS IS THAT GIVEN THE NATURE OF
THE BILL IN THE LICENSURE
EXACTLY.
SAMPLE SWITCHING ON MRI MACHINE
I DON'T THINK CAUSES FOR RE
REVIEW OF THE LICENSE WILL L. WE
HAVE TO THINK ABOUT WHAT KIND OF
THINGS WOULD ACTUALLY BE
TRIGGERED BY THIS BILL WHAT
LEVEL.
OF CHANGE I'VE WE WE WHAT WE
WANT TO GO OVERBOARD EITHER --
THEIR CELL AGAIN APPRECIATE
CONVERSATION CERTAINLY I THINK
MY STAFF.
LOOKING INTO THAT SO WE CAN COME
OUT YOU KNOW WE'RE NOT LOOKING
AT NIT PICKING.
YEAH CHANGES IN SERVICE VOTE
MORE TALKING ABOUT MAJOR CHANGES
SERVICE WHETHER YOU'RE LIMITING
TIRED DOUBLE OF THE HOSPITAL
CLOSURE ON ANY TIRE DEPARTMENTS
OR MAJOR CHANGES TO THOSE.
THESE TWO MAJOR DEPARTMENTS
WHERE THERE WOULD BE A
SIGNIFICANT IMPACT ON THE
COMMUNITY AND I THINK THAT
REALLY IS WHAT WE'RE TALKING
ABOUT I MEAN I KNOW THE SUBJECT
OF THIS IS HOSPITALS.
BUT REALLY WE'RE TALKING ABOUT
IMPACT THE COMMUNITY AND ABILITY
THE COMMUNITY TO NOW RESPOND TO
THIS BECAUSE THE HOSPITAL
OBVIOUSLY IS A VERY IMPORTANT
PART OF THE COMMUNITY THERE'S A
SET OF HEALTH CARE SERVICES
THEY'RE BEING DELIVERED BY THIS
INSTITUTION.
AND WHEN THAT INSTITUTION
DECIDES NO LONGER DELIVER THAT
WHETHER THROUGH CLOSURE OF THE
INSTITUTION ARE SOME CHANGE THAT
INSTITUTION.
WELL HOW MUCH TIME DO WE GIVE
THE COMMUNITY TO BE ABLE TO
ADJUST TO THAT AND TO RESPOND
AND EVEN SEEK AN ALTERNATIVE
PROVIDER OF THOSE SERVICES.
AND I THINK THAT'S THE ISSUE
WERE TRYING THAT WE'RE TRYING TO
DEAL WITH.
RECOGNIZING THAT WE ALSO YOU
KNOW WE NEED WE DON'T WHILE
THESE OTHER SERVICES BY --
UNDERCUTTING -- THE THE THE THE
THE THE THE HOSPITAL WHICH IS
LIVING OTHER SERVICES WELL OKAY.
ALL RIGHT SO I AM LET'S I THINK
I SAW CENTER RUBIO'S FIRST AND
AND THAT'S OUR GOV OKAY SIR
RUBIO.
YEAH AND I JUST WANNA MAKE SURE
THAT WE'RE ALL VERY CLEAR HERE
THAT I THINK EVERYONE.
ON THIS DíAS IF I MAY IS WERE
ALL VERY INTERESTED IN KEEPING
THE HOSPITAL'S OPEN WERE VERY
INTERESTED OF TAKING CARE OF OF
OUR YOU KNOW VULNERABLE
COMMUNITIES.
AND SO THIS IS NOT ABOUT BEING
ON BOARD ON THAT THAT
PERSPECTIVE AND AND I KNOW YOU
KNOW TO MY FRIEND FROM LOS
ANGELES IT MAYES.
SEEM LIKE A NO BRAINER BUT I'VE
HEARD THE AUTHORS AND I HEARD
THE OPPONENTS WILL SPEAK ABOUT
TEMPORARY WORKERS.
AND FOR ME WHEN WE'RE TALKING
ABOUT QUALITY CARE THIS SERVICE
IS VERY PARTICULAR YOU'RE
DEALING WITH PATIENT CARE.
SO WHEN I HEAR THAT WE'RE GOING
TO FULFILL YOU KNOW WE NEED
WORKERS WITH TEMPORARY WORKERS.
THAT IS AN ISSUE FOR ME AND I I
AND I REALLY APPRECIATE THE FACT
THAT YOU'RE WILLING TO WORK AND
AS DOCTOR PANDA EXPRESS ARE
STILL OTHER ISSUES THAT ARE ON
THE TABLE.
I ALWAYS OPEN TO SUPPORT AT A
LATER TIME WHEN ALL OF THESE
QUESTIONS HAVE BEEN ANSWERED BUT
AT THIS POINT AGAIN I WANT TO
JUST MAKE CLEAR WE ALL CARE
ABOUT PATIENTS WE ALL CARE ABOUT
OUR COMMUNITIES.
IT'S JUST MAKING SURE THAT OUR
PATIENTS DON'T SUFFER THE
CONSEQUENCES ARE UNINTENDED
CONSEQUENCES RATHER -- BUT I
DEFINITELY UNDERSTAND WHY YOU
WANTED TO BRING A FORTNIGHT
NIGHT DEFINITELY AGREE WITH OUT
DOCTOR POUND THAT IT'S A NOBLE --
QUESTIONS SORT OF TO BE IRONED
OUT THANK YOU.
JUST MISTER MISTER CARVER MAY
DELUDE YOU'D PROBABLY BE
SURPRISED HOW MANY OF TEMPORARY
WORK WORKERS ARE IN ANY HOSPITAL
ON ANY GIVEN DAY AND WE WE
TYPICALLY LABEL THEM TEMPORARY
BURNING IS REGISTRY.
I HAVE NEIGHBORS WHO DO THAT
THEY TYPICALLY GO BACK TO THE
SAME HOSPITAL QUITE OFTEN SO
THEY'RE VERY FAMILIAR.
WITH WITH WITH WITH THE CULTURE
OF THAT HOSPITAL LOGISTICS OF
THAT HOUSE WAS AGAIN THEY'RE
VERY THEY'RE THEY'RE A GOOD
NUMBER OF OF OF QUOTE UNQUOTE
TEMPORARY WORKERS -- ANY
HOSPITAL IN ANY GIVEN DAY.
AND AGAIN TO IN THE LONG BEACH
SITUATION THE INCENTIVIZED --
NURSES OTHER STAFF MEMBERS TO
STAY THROUGH THE LENGTH.
THE TO THE TO THE AID THE TIME
PERIOD DESIGNATED FOR UNTIL THE
CLOSURE HAPPEN AGAIN AS HAS BEEN
MENTIONED THE DEPARTMENT PUBLIC
HEALTH COULD COME IN NOW.
AND SHUT DOWN A HOSPITAL IF THEY
DID NOT HAVE ADEQUATE STAFFING
THAT'S TODAY.
ABSENT THIS BILL AND WE SHOULD
ALLOW THEM TO RETAIN THAT POWER
FOR SURE.
A SENATOR OF THANK YOU MISTER
CHAIR AGAIN AM I JUST LISTENING
TO THE CONVERSATION IT'S GOING
BACK AND FORTH -- BUT I WENT
THROUGH A RULE CLOSURE TULARE
COUNTY HOSPITAL WAS A ROAD
CLOSURE WAS IN THE SENATE IT'S
IN THE SENATE DISTRICT NOW BUT
IT WAS AN IN THE ASSEMBLY
DISTRICT WHEN -- WHEN I
REPRESENTED THEM IN THE ASSEMBLY
OR THE SOUTH PART THAT COUNTY
[inaudible]
AND THE BIG ISSUE THERE IS A
SOON AS EVERYBODY REALIZED IT
WAS AND I'M TECH AND WE WENT
THROUGH BOND MEASURES TO GET
ADDITIONAL TAXES TO FIND IT TO
HOLDING PEOPLE ACCOUNTABLE THAT
REVIEW MINISTRY TEARS. TO
WORKING WITH THE HOSPITALS TO
DOING EVERYTHING THERE IS A HUGE
CENTER FULLER WORK SO HARD TO
TRY TO ADDRESS THIS PARTICULAR
ISSUE.
BUT AS SOON AS IT CAME DOWN AND
THEY MISSED ONE PAYROLL NOT
BECAUSE THEY WERE BEING EVIL OR
MEAN BUT THERE WAS NO MONEY --
SO O FIND SOMETHING FOR A
HUNDRED EIGHTY DAYS WHEN THERE'S
NO MONEY WHERE DOES THE MONEY
COME FROM.
BECAUSE IN THIS PARTICULAR
SITUATION NURSES AND STAFF WAS
NOT GETTING PAID IN THE TULARE
COUNTY HOSPITAL WHEN IT WAS
BEING SHUT DOWN.
AND I AM VERY GRATEFUL THAT YOU
TOOK THE AMENDMENTS ON THE
EXPANSION BECAUSE IMMEDIATELY
THE BY SELLING A HOSPITAL HAD TO
STAND UP AND EXPAND.
ON THAT THIS SOME OF THEIR
FACILITIES SO THAT THEY CAN TAKE
A DELIVER MORE BABIES BUT THEY
DIDN'T HAVE THE ROOM SO THEY HAD.
TO SHUT DOWN SOME AREAS THAT
WEREN'T SO YOU KNOW VERY AFTER
SOME SOME STUFF THAT WAS BEING
USED ALL THE TIME.
BUT WE HAD TO MODIFY STUFF VERY
QUICKLY IN ORDER TO PROVIDE
SERVICES FOR OUR COMMUNITY.
SO I REALIZE IT TOOK A MINUTE
GOING ONE WAY BUT GOING THE
OTHER WAY IF IF THERE'S NO HOPE
FOR THE HOSPITAL CLOSURE.
AND TO BE BOUGHT OUT OR WHATEVER
IT IS YOU SIX MONTHS IS CRAZY TO
WAIT.
AND TO ALTER A NOTHER HOSPITAL
IT'S RECEIVING ALL THOSE
PATIENTS IN ORDER.
TO AND CUT OUT AN AREA THAT THEY
MAY NOT NEED A LIKE A BARIATRICS
PORTION MAYBE THEY REDUCE THAT
SIZE WHICH IS WAITING CAPITA BY
CELL YES.
THEY REDUCED A PORTION OF THE
HOSPITAL IN ORDER TO TAKE ON A
HIGHER -- HIGHER VOLUME OF
ACTIVITY WHERE PEOPLE NEEDED
MORE SERVICES IN A PARTICULAR
AREA BUT THIS IN ORDER TO DO
THAT I UNDERSTAND YOUR BILL WILL
REQUIRE THEM TO WAIT SIX MONTHS.
BEFORE THEY EVEN STARTED THAT
CHANGE AND I KNOW YOU'RE GOING
TO WORK WITH THE OPPOSITION
YOU'VE ALREADY SAID.
BUT THAT TO LARRY COUNTY
HOSPITAL CLOSURE GOING THROUGH
THAT AND TO SAY THAT RULE AREAS
ARE ALMOST EXACTLY LIKE THE REST
IN CALIFORNIA WE WANT OUR
HOSPITALS I MEAN THERE'S NO
DOUBT THAT MY COLLEAGUE FROM
TULARE ONCE OUR HOSPITALS TO
SUCCEED WE WANT TO MAKE SURE.
THAT THE PEOPLE IN RURAL
CALIFORNIA AND CALIFORNIANS
DON'T HAVE GREAT HOSPITAL
SERVICES BUT IT IS A DIFFERENT
RIDGECREST CLOSE DOWN THEIR
HOSPITAL WITH THE TRANSFER OF
DETACHED BE TAPPED TO BE HAD.
THE MODEL IN CHANGE THINGS AND
YOU KNOW THIRTY MILLION DOLLARS
AND THREE BALLOT MEASURES LATER
AND ALL THE SEISMIC AND
EVERYTHING THAT HAS TO GO
THROUGH TO BUILD A HOSPITAL TO
PROVIDE SERVICES. FOR OUR
COMMUNITY I JUST THINK THAT.
pI GET IT WE WANT TO MAKE SURE
THAT WE HAVE -- SERVICES BUT TO
PUT THIS BILL IN PLACE ON THE
GROUND WHEN THERE'S NO MONEY.
IN [inaudible] TO RETAIN.
I MEAN THERE'S NO REQUIREMENTS
AS NURSES OR MEDICAL WRITER
SERVICES HAVE TO SAY THE LAST
DAY TO PROVIDE SERVICES FOR THAT
COMMUNITY IF THERE IS NO ONE TO
TAKE IT OVER.
I IT'S JUST A HARD BILL TO GET
AROUND -- BECAUSE WE'VE GONE
THROUGH IT INTO THEIR UNIT IT
DOES THIS BILL DOES NOT WORK ON
THE GROUND.
THEY WERE GETTING PAID.
STAFF WAS AN UNPAID.
AFTER NINETY DAYS RIGHT -- TO
NOT GET PAID AFTER A HUNDRED
EIGHTY DAYS I AND THEN FILLING
THE SLOTS WHEN STAFF LEAVES THAT
SAID.
IT'S I JUST DON'T SEE IT WORKING
IN ON THE GROUND IF THAT MAKES
SENSE IN THEM.
REAL WORLD [inaudible]
JUST WANTED.
PRETTY MUCH THREE INTERVIEW WITH
MY COLLEAGUE AT JUST MENTION
RIGHT NOW.
WE SHARE TULARE HOSPITAL WE SEEM
TO STRUGGLE THERE [inaudible]
AND I I WANT TO WORK WITH YOU
GUYS I MEAN I'M I'M STRUGGLING I
I REALLY I'M WITH THE BILL -- I
WILL SAY I WILL SUPPORT YOU
TODAY.
AND I WANT TO WORK WITH YOU TO
MAKE AMENDMENTS SO THAT IT WORKS.
FOR THE VALLEY BUT I ALSO WANT --
TO FIVE YOU KNOW.
LET YOU KNOW THAT THAT I'VE YOU
KNOW RESERVE RESERVE MY RIGHT TO
TO NOT PUT OUT VOTE FOR IT ON
THE FLOOR IF IT DOESN'T.
WORK FOR THE VALLEY BECAUSE I I
HAVE A LITTLE BIT OF A CONCERN
THAT.
THIS BILL COULD IMPACT THOSE
HOSPITALS LIKE TULARE THAT
THEY'RE TRYING TO YOU KNOW THEY
JUST.
YOU KNOW TRANSITION INTO IT AND
TO A DIFFERENT ONE AND THEY'RE
TRYING TO SURVIVE -- WE ALWAYS
OBVIOUSLY WE ALL WANT TO KEEP
THEM OPEN BUT IT'S A LITTLE
DIFFERENT AND AND THE CENTRAL
VALLEY AND SO -- I REALLY
APPRECIATE THAT -- YOU'RE ALL
WORKING TOGETHER TO MAKE IT WORK.
I THINK THAT'S WHAT IT TAKES. TO
TO MAKE SURE THAT HOSPITAL'S
REMAIN OPEN THAT ARE COMMITTEE
MEMBERS HAVE CONTINUED HAVE
ACCESS -- TO A HEALTH CARE NOTS
OBVIOUSLY EXTREMELY IMPORTANT TO
ME IN MY DISTRICT AND SO THANK
YOU FOR WORKING TOGETHER I WILL
VOTE FOR IT TODAY BUT LOOKING
FORWARD TO WORKING WITH BOTH OF
YOU TO MAKE SURE THAT IT WORKS
FOR ALL OF US.
THANK YOU SIR MITCHELL.
OF QUESTION FOR YOU ON MISTER
CHAIR I APPRECIATE THE AUTHOR IS
SAID THAT THE THEIR TECHNICAL
TECHNICAL YET SUBSTANTIVE BASE
THE KINDS OF QUESTIONS AND
ISSUES THAT WE TALKED ABOUT.
AND WE'RE IN THE SECOND HOUSE
AND SO FROM YOUR PERSPECTIVE --
SO -- SO I THINK -- IN
APPRECIATE YOUR VALUES COULD BUT
WE ARE THE POLICY COMMITTEE AND
SOUNDS LIKE WE STILL SOME POLICY
ISSUES -- I UNDERSTAND FROM L.
MY STAFF WHO WERE NOT WE DO NOT
THINK THERE WAS SOME OF THAT.
ALL CHANGES WOULD BE BUT I ALSO.
RAY TWO CAME OUT AND WE DIDN'T
THINK THAT REALLY OF BUT WERE
BUT YOU KNOW WHAT WE ALSO LOVE
YOU SHOULD BECOME A GOOD PRODUCT
YOU HEARD THE MEMBERS OF THE
COMMITTEE I THINK THERE ARE SOME
CONCERNS -- NO I I APPRECIATE
YOU BRINGING THIS BILL FORWARD
BECAUSE I DO THINK WE WILL WE
NEED HE'S COMEDIAN MIND WHY HAVE
THE COMMUNITY HAVE TIME TO MAKE
THE ADJUSTMENTS I THINK THAT'S
THE PURPOSE YOUR BILL.
BUT I THINK -- GIVEN THAN WHERE
TO CONVERSATIONS BED AND AND AND
AND I THINK THERE ARE THINGS I
APPRECIATE YOU.
PERHAPS -- WITH -- WOULD BE
GRATEFUL TO HAVING JUST THE BILL
HOW OLD FOR SO WE CAN WORK SOME
OF THESE OUT BEFORE -- WE TAKE A
VOTE ON THE BILL SO SO YOUR
DESIRE IS TO HOLD THE BILL TODAY
JUST YEAH SO WE CAN HAVE THAT
CONVERSATION -- THAT SAYS SO
THAT TO WORK OUT SOME OF THE
ISSUES IN TERMS OF LIKE EXACTLY.
YEAH WE HAVE FOUR MORE HEARING
SO YOU HAVE PLENTY OF TIMES MY
NEXT QUESTION YES -- THEIR
FORMER HERE IS THAT THIS IS THE
VERY FIRST ONE FOR THE ASSEMBLY
LINE SO WE HAVE TIME TO WORK OUT
I A L. A. GENERALLY SUPPORT THAT
OBVIOUSLY YOU THANK YOU FOR
TAKING THE MINUTES I SUPPORT THE
BILL BUT I THINK THERE'S SOME
ISSUES THAT.
WE CAN WORK OUT HERE IN THE
COMMITTEE I THINK THE BILL WOULD
COME OUT STRONGER AND WITH MUCH
WITH US THAT'S A MORE MORE
THROUGH THE ESSEX SUPPORT -- AND
THAT MIGHT BE HELPFUL SO --
SINCE WE HAVE TIME IT WILL.
SELL.
THAT IS THAT IS YOUR DESIRE
MISTER CERTAINLY AGREE TO IT I
HAVEN'T AND AGAIN I I THOUGHT
THIS WAS WORKED OUT SO YEAH I'D
I THOUGHT SO TOO BUT I THINK
THAT -- SOUNDS LIKE IN TERMS OF
WHAT EXACTLY HOW MUCH OF A
CHANGE NEEDS TO HAPPEN BEFORE WE
TRIGGERED THE HUNDRED EIGHTY
DAYS SOUNDS LIKE IT'S STILL UP
IN THE AIR.
YES A SENTIMENTAL YES AND I JUST
WANNA BE CLEAR TO THE OFFER THAT
THAT MIGHT INQUIRE RE -- AND
SUGGESTED THAT IT BE HELD -- IS
WITHOUT PREJUDICE.
ALL WE HAVE PLENTY OF TIME -- ON
AND THAT'S THE POINT THAT'S THE
POINT OF THE POLICY COMMITTEE SO
I'D I DIDN'T WANT YOU TO ASSUME
THAT -- I MADE THE SUGGESTION IN
AN EFFORT TO KILL THE BILL AT
ALL THAT'S NOT THE CASE AT ALL
BECAUSE THIS IS THE FIRST
HEARING I KNEW THAT WE HAD TIME.
TO DO THE WORK FOR PEOPLE SO
SOME OF THE UNREST COULD PERHAPS
BE SOLVED -- OR NOT YEAH AND I
AND I THINK -- MY DESIRE OF
WOULD BE.
TO GET THE BILL OUT -- BUT I
THINK THAT WE DO A LITTLE MORE
WORK ON IT BECAUSE I THINK SOME
ADDITIONAL THINGS CAME UP TODAY
A FIVE EASIER. FOR FOR THE
COMMITTEE WITH PLENTY OF TIMES
THERE'S NO TIMING ISSUE AS
UNLESS.
SO I DECIDED TO DAD BEFORE YET
AND SEE WHAT YOUR THOUGHTS WERE
GONNA LISTEN I'M WILLING TO GO
TO WORK AND SEE IF WE CAN COME
UP WITH A COMPROMISE.
AND IN SOMETHING THAT WORKS THAT
REALLY DOES. FOR THE INTENT OF
THE BILL.
AS WELL -- AGAIN THAT THIS WAS
NEW INFORMATION TO ME TODAY THAT
THERE WERE STILL PROBLEMS I
THOUGHT WE'D TAKE THE ISLANDS
AND WE WERE IN A VERY GOOD SPOT.
AT IOWA AND I STAYED FOR MYSELF
AND I THANK YOU SO MUCH I AGREE
WITH YOU THIS IS NOT YOUR FAULT.
I THINK IN SOME SENSES -- SOUNDS
LIKE WE NEED TO DO A LOT MORE
WORK WITH I THOUGHT WE WERE IN
THE RIGHT PLACE BUT IT'S NOT
LIKE THERE'S STILL SOME
OUTSTANDING ISSUES WE STILL HAVE
SOMETIME MY DESIRES TO GET THIS
BILL OUT THE COMMITTEE -- SO I I
HOPE BUT I'M JUST SAYING THAT
HOPING THAT -- MAYBE WE CAN MAKE
SOME SOME FURTHER ADJUSTMENTS
THAT WAY AND WE WILL AGENDA IS
IT FOR A MEETING -- YES OF
COURSE NEXT WHAT FOR MEETINGS
AND YEAH PROBABLY EARLIER THAN
LATER.
WE CAN GET SO I THINK AND I
SINCE WE AND SINCE WE'VE HAD TO
DISCUSS AND I THINK SINCE WE'VE
HAD THAT DISCUSSION.
THE DESIRE WOULD BE JUST TO DO
IT IS A VOTE ON ABOUT ON THE
THAN YES THE CLINCHER.
OKAY THANK YOU I APPRECIATE IT
AND I SAID A LOOK FOR TO WORKING
WITH YOU AND GAS AND I
APPRECIATE AGAIN I THOUGHT WE
WERE IN THE RIGHT PLACE AND I
APPRECIATE.
YOU BEING YEAH AND WHAT WE'LL
WE'LL FIGURE THAT OUT THEN THANK
YOU I THANK YOU SO MUCH THANK
YOU.
OKAY -- ASSEMBLY MEMBER PATRICK
NORRIS THANK YOU FOR YOUR
PATIENCE -- SO ITEM NUMBER EIGHT
A V. TEN SIXTY THREE WELCOME.
SIX SEVEN THE AMENDMENTS
PROPOSED BY THE COMMITTEE THANK
YOU I FOR YOUR WORK AND ANALYSIS
ON THIS SIDE HELPING US MOVE IT
FORWARD.
I THE PURPOSE OF THIS BILL IS TO
PROTECT CALIFORNIANS AGAINST
ONGOING FEDERAL ATTEMPTS TO
UNDERMINE THE AFFORDABLE CARE
ACT.
THIS BILL WILL REQUIRE
LEGISLATIVE APPROVAL AND THE
STATE CHANGE IN STATUTE PRIOR TO
MAKING ANY CHANGES TO THE COVER
CALIFORNIA PROGRAM THROUGH THE
USE OF THIRTEEN THIRTY TWO
WAIVERS. THIRTEEN THIRTY TWO
WAIVERS ALLOWING STATES TO WAIVE
EXTENSIVE PORTIONS OF THE ACA.
AS PART OF ITS STRATEGY TO
UNDERMINE THE AFFORDABLE CARE
ACT IN OCTOBER OF TWENTY
EIGHTEEN THE FEDERAL
ADMINISTRATION.
ISSUED A NEW FEDERAL GUIDANCE
AND REINTERPRETATION OF THIRTEEN
THIRTY TWO WAIVERS.
DRAMATICALLY RELAXING WAIVER
GUARDRAILS.
UNDER THE NEW ADMINISTRATION
GUIDANCE SECTION THIRTEEN THIRTY
TWO WAIVERS GIVE STATES THE
ABILITY TO WAIT OUT OF OFFERING
COMPREHENSIVE COVERAGE ARE
COVERING A COMPARABLE NUMBER OF
PEOPLE.
THIS ACTION EXPOSES PEOPLE PRE
EXISTING CONDITIONS TO HIGHER
PREMIUMS OR LACK OF COVERAGE.
THE REINTERPRETATION ALSO ALLOWS
STATES TO PURSUE THIRTEEN THIRTY
TWO WAIVERS WITHOUT THE NEED FOR
EXPLICIT STATE LEGISLATION.
INSTEAD WAIVERS CAN NOW BE
AUTHORIZED FOR STATE REGULATION
OR BY AN EXECUTIVE ORDER.
IN CALIFORNIA IS AS YOU ALL KNOW
THE LEGISLATURE PLAYED A KEY
ROLE IN THE IMPLEMENTATION OF
THE AFFORDABLE CARE ACT HERE IN
CALIFORNIA.
AND SHOULD CONTINUE TO WEIGH IN
ON ANY MAJOR CHANGES REQUIRED A
WAIVER OF FEDERAL LAW.
WHAT WE DO NOT ANTICIPATE AT
THIRTEEN THIRTY TWO WAY FOR AT
THIS MOMENT?
I THINK WE ALL KNOW THAT MOMENTS
DO YOU CHANGE AND BELIEVE THAT
IT IS IMPORTANT AT THIS POINT TO
SHORE UP HE ACA IN CALIFORNIA
TO ANY POTENTIAL FUTURE THREATS.
AND TO CODIFY THE LEGISLATOR THE
TEACHER'S ROLE IN MAKING THESE
SORTS OF SWEEPING POLICY CHANGES
TO THE ACA.
I AB TEN THIRTY TEN SIXTY THREE
AT THE NECESSARY LAYER OF
PROTECTION TO THE ACA.
RESPECTFULLY REQUEST THE
COMMITTEE SUPPORT AND PLEASED TO
INTRODUCE TO SUPPORTERS HERE. TO
TESTIFY.
THANK YOU WITNESSES WHAT.
STEPHANIE MEDICARE MEMBERS JESS
CAM RANH ON HEALTH ACCESS
CALIFORNIA THE STATE WIDE
CONSUMER ADVOCACY COALITION WE
ARE PROUD CO SPONSORS OF AB TEN
SIXTY THREE WHICH IS REQUIRE
EXPLICIT -- APPROVE LEGISLATIVE
APPROVAL BEFORE ESTATE BEFORE
THE STATE CAN -- APPLY FOR
INTIMATE AT THIRTEEN THIRTY TWO
OVER TO THE FEDERAL GOVERNMENT.
AT THIRTEEN THIRTY TWO
INNOVATION RIVER ALLOWS STATES
TO PURSUE ALTERNATIVE WAYS OF
IMPLEMENTING THE ECA AS LONG AS
THEY ARE CONSISTENT WITH THE
ORIGINAL GOALS OF THE ACA.
WELL WE CANNOT IMAGINE
CALIFORNIA EVER USING A THIRTEEN
THIRTY TWO WAIVER TO UNDO THE
SPECIAL OF THE SUCCESSFUL
IMPLEMENTATION OF THE ACA WE
WANT TO ENSURE THAT THE
LEGISLATURE PUT CONTINUES PLAY A
KEY ROLE.
IN ANY FUTURE AT THIRTEEN THIRTY
TWO EVER CONSIDERATION THE SAME
WAY THEY DID IN INFINITY CA.
REGION'S RUSS HERE I ABOUT TODAY
THANK YOU.
GOOD AFTERNOON CHEN FLOOR ON
BEHALF OF WESTERN CENTER ON LAW
AND POVERTY -- I'LL BE BRIEF BUT
I WOULD JUST A NOTE THAT PART OF
THE REASON THAT CVERED
CALIFORNIA HAS BEEN SUCCESSFUL
IN CALIFORNIA IS BECAUSE OF THE
THOUGHTFUL IMPLEMENTATION WORK
THAT WAS DONE IN THE LEGISLATURE.
PRIOR TO THE LAUNCHING OF THAT
WE'VE SEEN IN A MUCH DIFFERENT.
EXPERIENCE IN MANY STATES THAT
ARE ON THE FEDERAL MARKETPLACE
FOR EXAMPLE -- THIS LEGISLATURE
HAS BEEN THOUGHTFUL AND WAIT IN
PREVIOUSLY ON WHAT IT CONSIDERS
TO BE JUNK INSURANCE AND
DECISIONS THAT ARE MADE IN WHAT
COVER CALIFORNIA CANNING CAN'T
OFFER AFFECT OUR MARKET AS A
WHOLE.
SO WHAT THIS BILL IS DOING IS
REALLY JUST MAINTAINING THE
STATUS QUO AND SAYING THAT --
CHANGES TO THE LAW SHOULD BE
HAPPENING THROUGH THE
LEGISLATURE AND WE RESPECTFULLY
ASK YOUR AYE VOTE.
THANK YOU OTHER WITNESSES IN
SUPPORT.
TAKE A BREAK A NATIONAL
ASSOCIATION OF SOCIAL WORK
CALIFORNIA CHAPTER IN STRONG
SUPPORT THANK YOU.
MILEY'S ABOUT REPRESENTING
CALIFORNIA CHRONIC CARE
COALITION IN SUPPORT THANK YOU.
WHEN A TERROR WHAT'S WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK IN SUPPORT?
THANK YOU.
OKAY ANY WITNESSES IN OPPOSITION.
SEEN ON QUESTIONS FROM COMMITTEE
MEMBERS.
IT'S BEEN MOVED ST A YES SIR
GROWTH HAVE ONE QUESTION AND
ONLY BECAUSE I'M CURIOUS ARE
THERE ANY OTHER STATE AGENCIES
THAT WE AS A LEGISLATURE REQUIRE
THEM TO COME BACK TO US FOR
APPROVAL FOR ANY NEGOTIATIONS
WITH THE FEDERAL GOVERNMENT
UNDER ANY CIRCUMSTANCES.
OR WILL THIS BE THE FIRST AND
THE ONLY.
ONE SO I THINK THAT THERE ARE.
MANY THURS EXTENSIVE EXAMPLES OF
WHERE YOU KNOW.
LEGISLATURE THE LEGISLATURE HAS
AUTHORITY AND SO MANY ARENAS.
TO IN A DEFINING STATUE WHAT'S
HAPPENING AT OUR STATE AGENCIES
AND I THINK WE WANT TO MAKE SURE
THAT THE AS A CO EQUAL BRANCH OF
GOVERNMENT WE MAINTAIN NOT
PARTICULARLY ON SOMETHING THAT'S
THAT'S THIS IMPORTANT.
I MEAN I AGREE I'M JUST BUT I'M
JUST ASKING IS THIS THE ONLY IS
THIS THE ONLY AGENCY THAT THE
STATE OF CALIFORNIA IS GOING TO
REQUIRE. TO COME BACK AND GET I
OUR APPROVAL.
AS A LEGISLATIVE BODY IN ORDER
TO NEGOTIATE WITH THE FEDERAL
GOVERNMENT ON BEHALF OF THE
CITIZENS OF CALIFORNIA THIS IS
THE ONLY EIGHT THE ONLY AGENCY.
SO I DON'T WHAT WE'RE NOT SEEN
THAT THERE'S A SPECIFIC SO
THERE'S HONEST THERE'S ON A
SPECIFIC AGENCY THAT WOULD BE
COMING TO US FOR APPROVAL WE'RE
SIMPLY SAYING THAT.
THE RESPONSIBILITY FOR MAKING
CHANGES TO THE AFFORDABLE CARE
ACT.
SHOULD NEED TO COME FROM
LEGISLATIVE STATUTE AND FROM THE
LEGISLATURE.
DID YOU WANNA AT HHS YEAH RIGHT
SO IN TERMS OF WHEN A WEAVER IS
ALLOWED THERE HAS TO BE A
FEDERAL STATUTE THAT AUTHORIZES
THE WAIVER TO HAPPEN IN THE
FIRST PLACE.
SO MOST AREAS OF CALIFORNIA LAW
THE FEDERAL GOVERNMENT IS NOT
SAYING GO AHEAD AND WAIT FOR A
LAW BUT IN THE AFFORDABLE CARE
ACT AND THEN OCCASIONALLY WITH
MEDICAID OR MEDICARE.
THERE ARE CERTAIN PROVISIONS
THAT CAN BE WAIVED AND THERE'S
CERTAIN GUIDELINES UNDER THAT SO
WITH MEDI CAL OR MEDICAID
PROGRAM LAST YEAR THERE WERE
SOME GUARD RAILS THAT WERE PUT
ON NGUYEN DH CS CAN'T WHAT KIND.
TYPES OF WAIVERS THEY CAN SEEK --
THE ACA ITSELF WAS THE STATUE
THAT SAID THAT WAIVERS WERE
ALLOWED BUT IT WAS SILENT ON HOW
A WAIVER WOULD BE SOUGHT.
PREVIOUSLY CALIFORNIA HAD
PRESUME TO DO IT THROUGH THE
LEGISLATURE WE SAW A WAIVER
PREVIOUSLY THAT WHAT THAT HAD
LEGISLATIVE AUTHORITY AND IT WAS
ONLY AND FALL WHEN THE TRUMP
ADMINISTRATION SAID WERE NOW
INVITING STATES TO DO WAIVERS
WITHOUT STATUTORY AUTHORITY.
THAT WE THOUGHT THIS LEGISLATION
WOULD BE NECESSARY.
I MEAN THE ONLY CONCERN THAT I
HAVE IN THIS IS A DAY TO JEAN
WHEN SIR I SUPPORTING YOUR BILL
I JUST AM TRYING TO UNDERSTAND
DO YOU KNOW IN JUST ASK SOME
QUESTIONS BECAUSE I AM CONCERNED.
THERE'S A ADVERSARIAL
RELATIONSHIP OBVIOUSLY THE
CALIFORNIA FEDERAL GOVERNMENT.
IN WE NEED WAIVERS AND AS A
MATTER OF FACT YOU GUYS THAT
CALIFORNIA PERMITTED PUBLIC
HEALTH IS AT FOR WAIVER IF THAT
WEAVER IS NOT EXTENDED BECAUSE
CALIFORNIA IS NOT COMPLY.
IS THIS A NOTHER I WAS A JAB IT
IS MY QUESTION I GUESS IS IS
THAT.
IF VALID WAIVERS THAT WE NEED
THAT WE APPLY FOR AS A STATE ALL
THE TIME WITH THE FEDERAL
GOVERNMENT AND THEY GRANT TO US
SO THAT WE CAN CONTINUE TO
PROVIDE SERVICES. TO THE
CONSTITUENTS THAT WE REPRESENT.
IS THIS IS THIS A A BILL AND I
GUESS IT GOES BACK TO MY
QUESTION THAT.
IS DEPARTMENT OF HEALTH AND
HUMAN SERVICES IS THIS THE ONLY
AGENCY THAT GOVERNS THIS THE YOU
KNOW TELLING YOU SEE ARE THEY
THE ONLY AGENCY WE'RE REQUIRING
TO COME BACK TO LEGISLATIVE
CONTROL AGAIN I DON'T THINK
ANYBODY'S ANSWERED MY QUESTION.
ARE THERE OTHER AGENCIES THAT
HAVE TO COME BACK FOR
LEGISLATIVE APPROVAL IN ORDER TO
NEGOTIATE WITH THE FEDERAL
GOVERNMENT ON ISSUES.
OR IS THIS THE ONLY ONE AND IF
THIS IS.
I DON'T SEE DID I DON'T MEAN IT
LIKE THAT I'M JUST TRYING TO SEE
IF IF THIS JUST CREASES MORE
HAVOC WHERE WE REALLY DO NEED
THAT WAIVER BECAUSE OUR
HEALTHCARE SYSTEM IS NOT IN LINE
LIKE IT'S SUPPOSED TO BE AND
THEY COULD JUST.
YOU KNOW NOT YOU SHE WAS A
WAVERING PENALIZE US AND PUNISH
AS AN ALL OF THAT SO WE NEED A
WAIVER.
IS THIS LIKE A DIG AT THEM AND
CAUSES ISSUES BECAUSE IT IS KIND
OF RETALIATORY ON BOTH SIDES.
AND I DON'T I DON'T THINK THIS
IS YOU KNOW I DON'T THINK THIS
IS RETALIX TELL YUR STORY AND I
DON'T THINK THAT THEY SHOULD BE
IN ANYTHING CONTROVERSIAL I
THINK IT'S JUST ESTABLISH AS AS
I SAID THAT.
THE FACT THAT WE WENT DECISIONS
ABOUT YOU KNOW.
WHERE WAIVERS ARE TIGHTENED HOW
THAT WANTED TO COME FROM THE
LEGISLATURE SO IT'S OF A MAJOR
STAR DRESSERS LISTS ARE AND I
THINK US THEIR MITCHELL MAY?
I ALSO HAVE SOME COMMENTS ARE AS
YOU MAY HAVE A SEPARATE QUESTION
BUT OFTENTIMES.
WE WILL -- ASKER REQUEST THE
ADMINISTRATION TO BE SURE THEIR
WAIVER PROPOSALS COME BEFORE US --
NOT JUST WAIVERS BUT OTHER TYPES
OF DECISIONS WELL SO FRANKLY --
I SEE THIS IS MORE -- US BEING A
BILL BE SURE WE EXERCISE
OVERSIGHT OVER THE
ADMINISTRATION -- ADD BECAUSE
WHAT HAPPENS IS THAT THEY DON'T
COME TO US AND THEN THEY GET THE
WAIVERS AND SUDDENLY NOW THE
LEGISLATURE'S FORCED TO DEAL
WITH OUR CONSTITUENTS SAYING
WELL PUBLIC ABOUT YOU KNOW WHY
IS THIS WAIVER.
NOW DISADVANTAGING OUR DISTRICT
OR WHATEVER ELSE SO I THINK THAT --
IN MY MIND THIS IS ABOUT.
OUR ABILITY TO OVERSEE THE
NATURE OF THE WAIVER THAT'S
BEING REQUESTED OF THE FEDERAL
GOVERNMENT TO BE SURE THAT IT --
THAT -- THAT WE CAN EXERCISE
OVERSIGHT OVER OVER THAT -- SO
THAT'S IN MY MIND IS REALLY WHAT
THE ISSUE IS AND I AND I
UNDERSTAND THAT I UNDERSTAND BUT
I'M TALKING ABOUT THE RECIPROCAL
WAIVER RIGHT THERE'S WE'RE
TALKING ABOUT A WAIVER. FOR S.
TO OBTAIN IN ORDER TO
COMMUNICATE WITH THE FEDERAL
GOVERNMENT AYE NEGOTIATION AND
I'M TALKING ABOUT THE WAIVERS
THAT WE REQUEST FROM THEM. TO IN
ORDER TO OPERATE TO DELIVER
SERVICES TO OUR OUR CONSTITUENTS
I GUESS MISSION THIS BILL
DOESN'T DO THAT I REALIZE THAT
THIS IS ONLY ONE WAY I WRITE
THAT.
BUT MY CONCERN IS THAT WE THERE
ARE TWENTY SIX WAIVERS RIGHT NOW
AT THE STATE OF CALIFORNIA IS
ASKING FOR ON BEHALF OF THE
FEDERAL GOVERNMENT.
AND I GUESS MY MY CONCERN IS IS
THAT IF WE REQUIRE STATE
AGENCIES TO ELONGATE THAT
PROCESS WHICH IS BILLED AS FOR
ONE AGENCY.
AND IT WHERE DOES THAT TAKE US
WHEN WE NEED SOMETHING FROM THEM.
WELL I THINK WHAT AGAIN WHY AM
IS IS THIS IS A WAIVER THAT
CALIFORNIA WILL BE REQUESTING.
AND ALSO -- ESPECIALLY GIVEN THE
NATURE OF THIS WAIVER SO IT'S
NOT EVEN BROADLY FOR EVERYTHING
THE HEALTH.
THE H. T. S. DOES ITS FIRST VERY
SPECIFIC TYPE A WAIVER YES THAT --
THAT CAN HAVE A BIG IMPACT SO I
THINK THAT THAT'S WHY WE WANT TO
KNOW -- AND WE GO THROUGH THIS A
LOT ALSO IN OTHER PROCESSES TO
THE GUIDE THE THE ADMINISTRATION
ALSO WILL WE DON'T NEED
LEGISLATIVE APPROVAL OVERSIGHT
WILL AY NO YES WE DID YOU DO
BECAUSE WE WANT TO KNOW WHAT IT
IS THAT YOU'RE GOING TO BE DOING.
RIGHT OTHER THROUGH WAIVER
THROUGH SOME OTHER ACTION AS
WELL THAT'S THERE THAT'S A
CONSTANT ADVOCATE SO I THINK
THAT YOU KNOW BACK TO TO YOUR
QUESTION I THINK IT WAS AT THE
HEART OF YOUR QUESTION I THINK
IT'S MOE ABOUT GOOD GOVERNANCE
IS THEN.
YOU KNOW AND ATTEMPTED TO DO
SOMETHING THAT'S RETALIATORY.
INFLAMMATORY IT'S JUST IN WHAT
WE BELIEVE TO BE GREAT AND I AND
I DON'T MEAN TO SAY THAT IT'S
OUR TALENT -- I'M JUST SAYING
THAT I WANTED TO BE PERCEIVED
AND I GET AIDS AGAIN IT'S JUST
WE DON'T REQUIRE IT MY
UNDERSTANDING IS RESEARCH
CONSULTANT ADVICE WE DON'T
REQUIRE THIS FOR ANY OTHER STATE
AGENCY.
THEY DON'T HAVE TO COME WITH US
WHEN THE ADMINISTRATION
NEGOTIATES ON WAIVERS WITH THE
FEDERAL GOVERNMENT THE
ADMINISTRATION NEGOTIATES THESE
WAIVERS.
AND SO WE HAVEN'T BEEN ABLE TO
FIND ONE OTHER TIME THAT WE
REQUIRE THE ADMINISTRATION TO
COME TO LEGISLATIVE APPROVAL TO
NEGOTIATE A WAIVER.
FROM THE FEDERAL GOVERNMENT IN
ARMY VOTER RIGHTS ACT AS MATTER
THERE'S THERE'S A TON OF THEM.
HUESO I DON'T TO TIE THE HANDS
OF THE LEGISLATURE THE
ADMINISTRATION TO NEGOTIATE WITH
THE FEDERAL GOVERNMENT IF.
IT TAKES US AWHILE TO GET OUR
OKAY WELL ANYTHING I ANDLET ME
LET YOU KNOW LET ME KIND OF TAKE
THAT AWAY AND THEN COME BACK TO
YOU WITH.
AN ANSWER TO THAT QUESTION HERE
OKAY SIR MITCHELL MITCHELL.
HELP ME RIGHT OKAY ALL RIGHT.
OKAY I I WOULD JUST SAY IS IS
THAT IT -- ACROSS VARIOUS
AGENCIES AND PROGRAMS -- IN.
AND ARE EXERCISING OUR OVERSIGHT
THAT WE WILL ASK WHETHER IT'S
RELATED WAIVERS OTHER TYPES OF
THINGS.
WE WILL WANT -- TO HAVE THE
ADMINISTRATION IS THE REPORT
BACK TO US WHAT THEY'RE DOING
ALL ARE AT PARTICULAR CRITICAL
TIMES ACTUALLY SEEK OUR APPROVAL
ESPECIALLY IN THE INTERACTIONS
OF THE FEDERAL GOVERNMENT.
BECAUSE SOMETIMES THE
MINISTRATION LEGISLATURE DON'T
ALWAYS AGREE AND ACTUALLY I
WOULD POINT OUT OF PROBABLY
MENTION THAT AS A MEMBER OF THE
MINORITY PARTY -- THAT YOU
ACTUALLY HAVE A SHOT WHEN THE
LEGISLATURE HAS TO TO SAY THAT
THE LEGISLATURE HAS TO HEAD SAY
SOMETHING BECAUSE I DON'T THINK
THERE'S A LOT O OF REPUBLICANS --
NO THREE PEOPLE REGISTER FELL
INTO OUR IN THE ADMINISTRATION
WHO ARE GOING TO BE SPEAKING OUT
SO WHEN HE COMES BACK TO US WE
ALL HAVE A CHANCE TO COMMENT AND
OUR OUR OUR OUR YOU KNOW OUR
VIEWS KNOWN.
AND CUT IT IN RELATION TO WHAT
THE THE ADMINISTRATION MAY
PROPOSE AND HER CONVERSATION
WITH THE FEDERAL GOVERNMENT.
ANY OTHER COMMENTS THEN.
RIGHT OKAY IS THERE A MOTION
OKAY OKAY THERE'S THE BILL'S
BEEN MOVED -- ALL RIGHT AT WHICH
LIKE THE CLOTHES RIGHT THANK YOU
I AM SO.
THANK YOU TO THE COMMITTEE
MEMBERS FOR YOUR YOUR COMMENTS
AND FEEDBACK AND I WILL CYCLE
BACK WITH YOU ON THAT.
ON AS A SAID AB TEN SIXTY THREE
ADDS A LAYER PROTECTION TO THE
AFFORDABLE CARE ACT HERE IN
CALIFORNIA.
BY REQUIRING FEDERAL AT SORRY
STATE LEGISLATIVE APPROVAL
SPECIFICALLY FOR SECTION
THIRTEEN THIRTY TWO WAIVERS.
RESPECTFULLY ASK FOR THE
COMMITTEE SUPPORT AND FOR YOUR
I'VE.
THANK YOU ALL RIGHT SO THE
MOTION IS -- TO PASS WITH THE
AMENDMENTS -- THANKS FOR TO
ACCEPTING AMENDMENTS SECTOR
PLEASE CALL THE ROLL.
PAN HI CAN I A STONE.
STONE NO THE RAZA.
DRUGS -- I GROW [inaudible]
HER TADO.
HER TITLE I LEYVA.
LEYVA I MITCHELL.
MITCHELL AYE MONNING RUBIO
[inaudible]
I SIX THE BILL CURRENTLY HAS --
IT'S SIX ONE A WILL HOLD THE
ROLE OPEN FOR ABSENT MEMBERS
THANK YOU THANK YOU VERY MUCH
THANK YOU.
OKAY -- LET'S GO.
JEFF OKAY -- OKAY SO IS THAT I
UNDERSTAND CENTER STONE YOU'VE
MOVED THE CONSENT CALENDAR.
OKAY SO LET'S -- GO AHEAD BRING
TAKE UP THE I CONSENT CALENDAR
SO WE HAVE FIVE THREE AT SEA.
FOR ITEMS ON THE CONSENT
CALENDAR ITEM NUMBER ONE EIGHTY
FOUR FIFTY THREE ITEM NUMBER
THREE EIGHTY SIX NINETEEN ITEM
NUMBER FOUR IS AB SEVENTY ABLE
SEVEN EIGHTY ONE AS AMENDED.
ON THE CONSENT CALENDAR AND THEN
ITEM NUMBER -- FIVE EIGHTY EIGHT
FIFTY ONE SO IT'S BEEN MOVED BY
CENTER STONE -- SIX TWO PLEASE
CALL THE ROLL.
CAN I PAN AYE STONE AYE STONE
AYE DORADO DRUGS -- I GROW.
GROVE I FURTADO FURTADO AYE
LEYVA.
LEYVA AYE MITCHELL.
SO I MONNING RUBIO [inaudible]
RUBIO HI. NINE EIGHT SO THAT THE
THE CONSENT DOLLARS EIGHT VOTES
WILL HOLD THE ROLL OPEN FOR
ABSENT MEMBERS -- THAT INCLUDES
THE AGENDA OF THE SENATE
COMMITTEE ON HEALTH -- BUT WE
WILL CONTINUE.
TO I WILL CALL FOR ABSENT
MEMBERS -- TO COME -- OF THOSE
THANK YOU.
MEMBERS WHO HAVEN'T VOTED SO
LET'S GO AND GO THROUGH THE ROLE
FOR ABSENT MEMBERS RIGHT NOW.
OKAY SO WE'RE GONNA START WITH
THE ITEM AND NUMBER -- TWO
EIGHTY FIVE SIXTY FIVE
MAIENSCHEIN ACEKARD PLEASE CALL
THE ROLL OF ABSENT MEMBERS THERE
ALSO.
DRAWS A I MONNING RUBIO.
JUST VERIFICATION ITEM YES.
IF THEY ACCEPT AMENDMENTS.
YEAH YES YES YES OKAY.
RUBIO I OKAY THAT. ONE EIGHT THE
BILL HAS EIGHT VOTES SO WE'LL
KEEP THE BILL ON CALL -- ITEM
NUMBER SIX EIGHTY NINE NINE
THREE THAT'S A GOOD PLEASE CALL
THE ROLL OF ABSENT MEMBERS THE
RAZA.
TORONTO HI [inaudible]
MONNING.
OKAY THAT BILL CURRENTLY HAS
EIGHT VOTES WILL KEEP THE ROLE
OF CONTRACTS MEMBERS ITEM NUMBER
SEVEN EIGHTY TEN FOURTEEN FACE
ARE O'DONNELL.
I WAS A WEE HAS RIGHT WE HELD
THAT OVER SORRY THAT'S CORRECT
AND AND AND AND I THINK ITEM
NUMBER EIGHT WE'RE ALL RIGHT SO
THANK YOU SO VERY MUCH -- I WILL
CONTINUE [inaudible]
TO HOLD THE THE F. TEARING OPEN
FOR OUR REMAINING ABSENT NUMBER
.
PREFERRED OVER I OKAY
[inaudible]
OKAY [inaudible]
SO -- ALL RIGHT.
OKAY.
SO THANK YOU SO WE'LL GO AHEAD
AND CALL THE ROLL FOR ABSENT
MEMBERS STARTING WITH ITEM
NUMBER TWO EIGHTY FIVE SIXTY
FIVE BY SOME MEMBER MAIENSCHEIN.
A SECTOR PLEASE CALL THE ROLL
ABSENT MEMBERS MODERN.
AS AMENDED YES IT SAID TO PASS
AS AMENDED TO APPROPRIATIONS
ACCEPTED THE AMENDMENT.
YES BUT DESPITE A CHAIR.
MONNING HI OKAY SEVEN THAT BILLS
OUT NINE ZERO X. ITEMS ITEM
NUMBER SIX EIGHTY NINE NINE
THREE BY SOME EVER DOES ARIAN --
TO PASS TO APPROPRIATIONS TO
SUPPORT THE CHAIR -- SIX OF
THESE CALLABLE THE ABSENT
MEMBERS WANTING.
MORNING I NINE NOW THAT BILLS
OUT -- NINE ZERO AN ITEM NUMBER
SEVEN WAS -- IS BEING HELD IN
COMMITTEE AT THE MOMENT -- FOR
HOPEFULLY COMING WILL EXPECT TO
COME BACK AT A FUTURE MEETING
HEARING -- ITEM NUMBER EIGHT AB
TEN SIXTY THREE BY PATCHING
NORRIS -- THE MOTION IS TO PASS
WITH AMENDMENTS WHICH THE DOCTOR --
POSED IN SUPPORT WITH THE CHAIR
THEY REFUSE CALL THE ROLL ABSENT
MEMBERS GROVE MORNING.
MORNING I THAT BILLS OUT SEVEN
ONE AND FINALLY HAVE THE CONSENT
CALENDAR WITH FOUR ITEMS ON THE
CONSENT CALENDAR SIX THREE
PLEASE CALL THE ROLL OF ITEM --
ABSENT MEMBERS MONEY.
MORNING I NINE OKAY DISCONTENT
CALENDARS APPROVED NINE ZERO
THAT CONCLUDES THE AGENDA OF
THIS HEARING OF THE SENATE
COMMITTEE ON HEALTH.
THANK YOU THANK YOU.
MUCH I BUT THAT WE ARE ADJOURNED