►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
Welcome
to
the
fifth
meeting
of
the
interim
joint
committee
on
health,
family,
health
and
family
services,
health,
welfare
and
family
services,
and
we
do
have
a
full
agenda
as
always.
So
I
just
want
to
thank
the
folks
who
are
here
in
the
audience
and
everyone
watching
and
listening
on
zoom
just
a
reminder
to
any
members
who
are
participating
remotely.
Everyone
should
be
muted
unless
you
are
actively
speaking
in
the
meeting
and
please
use
the
chat
feature
to
notify
staff.
A
B
B
D
D
B
B
B
A
A
A
Really
kind
of
see
where
we
are,
how
we're
doing
and
talk
a
little
bit
about
hospital
capacity
and
also
discuss
as
part
of
this
conversation,
I
think
we'll
go
from
one
transition
fairly
easily
to
the
other
talk
about
the
hospital
shortage.
So
first
I'd
like
to
invite
nancy
galvani,
jim
musser
and
online,
we
should
have
dr
irfan
bhudani
with
us
to
discuss
the
vaccination
rates
and
actually,
if
I'm
not
sure
if
the
cabinet
is
online
yet,
but
if
they
have
anything
to
add
in
this
respect,
that
would
be
welcome
as
well.
I
I
Very,
very
important
concerns,
particularly
the
staffing
issues
with
our
hospitals,
so
I
am
going
to
hit
vaccination
capacity
and
staffing
while
I'm
here
so
as
we
reported
to
you
earlier
this
month,
kentucky
is
facing
an
unprecedented
surge
in
covet
19
cases
in
the
hospital
due
to
the
delta
variant
and
because
the
number
of
coven
19
hospitalizations
is
so
high.
It's
actually
well
exceeded
the
highest
number
that
we
had
earlier
in
the
pandemic
as
of
last
week
and
the
numbers
move
around
a
lot.
The
number
of
hospitalized
individuals
with
covet
19
was
over
2500
people.
I
Our
hospitals
have
responded
to
this
increase
in
demand
by
adding
over
200
additional
icu
beds,
just
within
the
last
three
weeks
to
meet
this
increased
demand,
and
yet,
even
after
doing
that,
there
was
fewer
open,
icu
beds
available,
because
the
beds
were
being
filled
as
fast
as
we
could
create
them,
even
with
more
than
200
beds
added.
The
demand
has
been
so
great
that
there
were
fewer
icu
beds
available
yesterday
compared
to
august
24th.
I
I
I
I
The
crisis
continues
to
be
primarily
among
the
unvaccinated.
Approximately
58
percent
of
the
population
of
kentucky
is
fully
vaccinated.
Statewide
over
92
percent
of
hospital
admissions
for
coven
19
since
march
are
among
unvaccinated
individuals.
It's
consistent
across
the
commonwealth
in
all
of
our
hospitals.
Large
small
rural
urban,
about
95
percent
of
the
coveted
patients
in
icu
are
unvaccinated.
I
All
of
this
means
that
there
are
fewer
open
beds
and
particularly
icu
beds,
to
meet
the
needs
of
other
patients
that
have
medical
needs
for
that
care.
Cancer
patients
need
that
care.
Cancer
cases
haven't
gone
away,
automobile
accidents
haven't
stopped,
heart
attacks
haven't
stopped
strokes,
you
can
go
on
and
on
just
because
we
have
the
pandemic,
but
because
of
this
pandemic,
our
hospitals
have
less
capacity
to
treat
these
other
illnesses.
I
I
We
expect
cms
to
issue
an
interim
final
rule
with
this
requirement.
Within
the
next
few
weeks,
fully
vaccinated
staff
are
available
at
the
bedside
to
care
for
patients.
Unvaccinated
staff
are
not
always
available
to
tend
to
patients
because
oftentimes
these
staff
have
to
be
in
isolation
or
quarantine
due
to
an
exposure
or
testing
positive
for
covid.
We
talk
to
hospitals
every
week,
all
across
the
state
and
many
are
reporting
a
huge
number
of
their
staff
that
are
off
in
quarantine
or
isolation.
I
I
The
number
one
concern
for
all
kentucky
hospitals
that
we
hear
over
and
over
again
is
staffing.
As
we
reported
earlier
this
month.
The
number
of
staff
beds
has
begun
to
diverge
significantly
from
the
number
of
licensed
beds
and
that's
because
of
staffing
hospitals
are
facing
a
shortage
of
nurses
and
other
qualified
staff,
and
that
limits
the
number
of
patients
that
hospitals
can
serve.
I
There
are
more
than
150
000,
open,
nursing
positions
nationwide
and
several
thousand
open
positions
in
kentucky.
We
want
to
be
clear,
however,
that
the
staffing
shortages
are
not
new
they've
been
growing
for
some
time
covet.
19
has
simply
sped
up
the
problem
and
shown
a
very
bright
spotlight
on
it.
Kentucky
like
the
rest
of
the
country
is
facing
a
demographic
black
swan
in
health
care.
I
Baby
boomers
have
begun
retiring
in
large
numbers,
and
that
includes
health
care,
fewer
nurses
and
other
qualified
health
care
professionals
are
coming
through
the
educational
pipeline,
and
that
means
not
enough
new
workers
to
replace
the
ones
that
are
retiring.
The
demand
is
driving
up
the
cost
for
staffing.
I
Our
hospitals
are
paying
significantly
more
for
staff
both
to
retain
their
current
staff
and
to
bring
in
agency
nurses
to
help
fill
some
of
the
gaps.
Hospitals
have
increased
the
hourly
rates
for
their
staff,
plus
they're,
paying
retention
bonuses
plus
they're
paying
bonuses
for
their
current
staff
to
work
additional
shifts.
I
Coveted
patients
are
extremely
sick,
our
staff
are
exhausted
and
even
the
offer
of
additional
money
often
is
not
enough
for
our
staff
to
agree
to
work
additional
hours.
As
we
have
previously
stated,
kentucky
hospitals
are
in
competition
with
other
states,
not
just
within
our
state,
but
all
across
the
country
for
a
limited
number
of
traveling
nurses.
I
According
to
a
recent
study
by
qualifis
and
that's
a
national
staffing
company,
the
market
rate
for
traveling
nurses
is
increased
from
about
a
hundred
and
sixty
dollars
an
hour
in
july.
To
now
over
two
hundred
dollars
in
september.
As
you
may
recall,
kentucky's
reimbursement
from
medicare
is
one
of
the
lowest
in
the
country.
I
I
Our
hospitals
tell
me
that
they
cannot.
They
cannot
sustain
the
amounts
they're
having
to
pay
for
staffing
in
2020
kentucky
hospitals
lost
2.6
billion
due
to
covet
from
loss
revenue
and
additional
costs.
One
billion
of
that
amount
was
not
covered
by
the
federal
provider
relief
funds.
From
the
cares
act,
there
have
been
no
more
federal
relief
payments
to
the
hospitals,
despite
the
ongoing
costs
related
to
this
search.
I
I
We
would
ask
that
you
support
an
appropriation
to
help
hospitals,
retain
our
current
staff
and
recruit
additional
staff
to
make
sure
that
we
can
serve
our
patients.
Your
constituents
as
helpful
as
an
appropriation
would
be.
It
will
not
be
a
panacea,
but
it
would
provide
needed
immediate
relief
to
enable
our
hospitals
to
expand
their
front-line
staff
and
to
relieve
the
strain
on
capacity
and
care
at
the
bedside.
I
As
we
previously
reported,
arkansas
has
already
provided
help
to
their
hospitals
from
the
state's
federal
arpa
funds,
which
are
intended
to
be
used
to
help
with
the
cost
of
staffing
in
hospitals
and
other
health
care
facilities.
Arkansas
has
now
been
joined
by
other
states,
including
mississippi,
arizona,
alabama,
texas,
michigan
and
kansas,
just
to
name
a
few.
I
I
Looking
at
a
post-pandemic
world,
which
we
hope
we
can
get
back
to
our
health
care
system
will
continue
to
face
the
growing
demographic
problem
and
the
question
becomes
how
to
address
it.
Kha
is
establishing
a
new
workforce
committee,
which
will
be
looking
at
ways
to
improve
the
numbers
of
new
health
care
workers
coming
through
the
educational
system,
we'll
be
looking
at
issues
in
addition
to
just
the
supply
but
including
workplace,
violence,
burnout
and
resilience.
I
We
also
intend
to
reach
out
to
kentucky's
four-year
institutions,
because
there's
opportunities
there
as
well.
Our
hospitals
have
been
examining
how
to
encourage
high
school
students
to
pursue
a
career
in
health
care.
Our
plan
is
to
work
with
the
kma
and
the
kna
and
with
other
organizations
to
confront
our
common
challenges.
A
All
right,
thank
you
so
much
that
was
a
lot
of
information
and
you
know
a
lot
of
really
valuable
information.
I
think
that
we
we
all
needed
kind
of
an
update
when
you
just
quickly
when
you're
looking
at
the
vaccination
rate
in
kentucky.
Are
you
taking
the
percent
of
the
total
population?
Are
you
deriving
that
number
from
the
eligible
population
I've
read,
I've
read
two.
H
A
Is
total
too,
because
I
I've
read
something
recently
that
talked
more
about
eligible
population,
and
you
know
those
of
course
would
be
individuals,
12
years
and
older,
and
we
were
closer
to
70
to
71
percent
of
our
of
our
eligible
population
who
had
been,
who
had
at
least
received
at
least
one
vaccination.
A
So
I
thought
that
was
positive,
so,
but
you
know
it
is,
it
is
kind
of
a
slow
process
and
I
certainly
appreciate
your
efforts
and
the
efforts
of
so
many
other
health
care
organizations
who
are
putting
out
public
service
announcements
and
really
trying
to
get
accurate
information
out.
I
think
what
I'll
do
right
now.
We
do
have
a
couple
of
questions.
I
guess
I'll
go
ahead
and
ask
senator
berg
to
ask
your
question:
are
you
online
senator
burke?
Thank
you.
Thank.
B
A
B
Very
very
informative
and
actually
concise
presentation.
There's
just
one
one
piece
of
information
that
I
had
received
that
I
wanted
to
share
with
the
group.
Uofl
put
out
an
email
earlier
this
week
that
up
there-
and
I
forget
honestly,
if
the
number
was
twelve
thousand
or
sixteen
thousand
employees,
only
five
had
refused
to
get
vaccinated.
B
A
Okay,
thank
you
senator
berg.
I
think
at
this
point
just
to
allow
dr
bhudani
to
present,
and
I
know
that
you
have
to
get
back
to
work.
What
what
I'll
do
is
I'll.
Let
dr
bhudani
give
us
some
information
about
what
I
wanted
to
know
from
you,
dr
bidani,
and
we
had
this
conversation
in
the
hospital
last
week
or
a
week
and
a
half
ago
kind
of
who
are
you
seeing
in
the
hospital
who
who
are
these
patients?
What
are
their
ages?
A
K
And
thank
you
very
much.
I
appreciate
the
invitation
to
come
and
talk
to
you
and
you
know:
we've
been
at
this
for
18
months
almost
and
things
have
changed
in
the
last
18
months.
The
kind
of
patients
we're
seeing
have
changed.
We've
had
multiple
spikes
in
the
last
18
months
and
it
has
seemed
at
least
to
us
on
the
front
lines
looking
after
these
icu
patients
that
every
subsequent
spike
has
been
worse
than
the
previous
one
and
with
the
latest
delta
spike.
K
Our
patients
are
much
younger,
much
sicker
than
any
of
the
previous
spikes
that
we've
had,
and
the
majority
of
this,
as
previously
mentioned,
is
being
driven
by
unvaccinated
individuals,
and
I
would
like
to
add
that
this
disease
is
a
preventable
illness.
K
We
have
good
efficacy
for
the
vaccine
and
there's
multiple
data
published
out
there,
but
we
are
seeing
younger
sicker
patients.
We
are
having
difficulty
transferring
patients
for
tertiary
level
care.
For
example,
we
had
a
young
38
year
old
pastor,
who
was
very
sick.
Last
a
couple
of
weeks
ago
had
refused
to
get
vaccinated.
The
whole
family
got
sick,
including
some
of
his
older
relatives.
Everyone
else
did
well
except
him.
He
was
the
youngest
and
healthiest
and
he
got
deathly
ill
and
the
family's
question
was
we
thought
he
would
do
fine.
K
Why
is
he
the
sickest
and
the
answer?
Is
we
don't
know
right,
but
that
question
would
maybe
would
not
have
come
up
if
the
vaccine
had
been
had
been
taken,
but
anyway
he
was
sick
enough.
He
ended
up
requiring
what
is
known
as
vino
venus
extra
corporeal
membrane
oxygenation,
which
is
a
bypass,
and
we
initiated
that
our
institution
and
then
were
looking
for
a
tertiary
institution
to
take
this
patient
and
we
could
not
find
an
open
bed
for
vv
at
mom
in
entire
of
ohio,
including
osu
cincinnati
university
of
kentucky
university
of
louisville
vanderbilt.
K
We
called
atlanta.
All
the
atlanta
system
areas
were
full,
we
called
university
of
chicago,
everyone
was
full
and
we
we
had
to
keep
the
patient
and
and-
and
we
were
able
to
get
him
through
it
and
he's
doing
better
now,
but
that's
the
degree
of
desperation.
Sometimes
you
face
with
this
critically
ill
young
patients
who
you're
trying
to
save,
but
your
resources
are
getting
stretched
thin.
K
So
we've
also,
of
course
dealt
with
this
face
to
face
where
we
see
the
the
the
desperation
in
your
patients
faces
when
you're
about
to
put
them
on
a
breathing
machine
and
a
lot
of
times.
They
express
regrets.
You
know
about
not
getting
the
vaccine
or
not
wearing
a
mask
or
going
to
their.
You
know
family
outing
with
other
people
and
a
lot
of
times.
You
know
it's
too
late
by
then.
K
Say
we
are
ready
to
take
the
vaccine
now,
but
you
know
it's
too
late,
so
I
would
like
to
emphasize.
This
is
a
preventable
illness,
and
I
appreciate
everything
that
is
being
done
from
everyone
about
trying
to
put
forth
the
message
that
there
is
ways
to
prevent
this.
The
patients
are
younger,
they're
getting
sicker,
and
even
though
there
has
been
a
plateau,
the
numbers
are
still
very
high.
Resources
are
extremely
stretch
thin
and,
and
you.
K
Hard
as
they
can,
but
you
know
there
is
going
to
be
a
point
when
resources
may
not
be
adequate,
as
in
the
case
of
vv
ecmo,
where
we
could
not
find
a
bed
across
multiple
states
for
this
patient
and
we
had
to
keep
the
patient
here
and
manage
him
here.
So
that
is,
that
is
my
input.
If
there's
any
other
questions,
you
have
I'd,
be
willing
to
answer
them.
A
Thank
you
so
much.
I
I
really
appreciate
your
being
here.
I
know
that
you're
you're,
busy
taking
care
of
patients
so
pulling
you
away
is
is
is
certainly
a
big
ask
so,
but
we
do
have
a
couple
of
questions.
I'm
going
to
ask
co-chair
alvarado
to
ask
his
question.
First,
please.
H
Thank
you,
madam
chair,
dr
bhudani.
Thank
you.
I
think
for
the
I
know
when
we
use
the
term
ecmo
and
healthcare
we
as
physicians.
We
know
what
that
means.
When
we
talk
about
extracorporeal
membrane,
oxygenation,
it's
a
fancy
term,
but
for
members
of
the
committee
and
for
those
who
are
watching
what
that
basically
means
is
you
put
a
tube
into
someone's
venous
system?
H
You
take
the
blood
out,
you
oxygenate
it
outside
the
body,
and
then
you
pump
it
back
in
because
the
lungs
are
so
damaged
or
so
diseased
that
they
cannot
allow
oxygen
to
be
transmitted
through
the
vessels
there
into
your
bloodstream,
like
we
would
normally
do
when
we
take
a
breath,
it's
so
plugged
up
so
damaged
that
you
can't
do
it
that
you've
got
to
have
a
fancy
machine
to
do
that.
We
often
do
for
babies
with
cardiac
problems
and
obviously
in
adults
that
are,
you
know
that
we
think
have
a
chance
to
survive.
H
So
maybe,
dr
madonna,
you
could
talk
about
I'd
like
to
know
from
your
perspective
as
a
doctor.
Obviously
a
pulmonologist.
What's
the
strain
like
what
are
you
observing
in
the
hospitals
from
our
healthcare
workers,
from
our
nurses,
from
our
doctors?
How
much
toll
is
this
taking
on
them
right
now,.
K
So
I
appreciate
your
question.
Thank
you
very
much
and
it
is
taking
quite
a
bit
of
a
toll.
You
know
I
mean
people
like
I
said
have
been
at
this
for
18
months
and
counting
and
people
are
getting
burned
out.
We
have,
you,
know
healthcare
providers
that
are
thinking
about
switching
careers,
healthcare
providers
that
are
thinking
about
retiring
healthcare
providers
that
are
going
into
completely
non-health
related
fields,
because
you
know
the
the
pressure
and
the
stress
of
the
last
few
years
has
been
extreme.
I
know
a
lot
of
my
colleagues
have
ptsd.
K
You
know
I
mean
to
be
honest,
you
know
we
you
you,
you
go
to
bed
at
night
and
you
can
still
hear
the
ventilator
alarms
and
the
pump
alarms
going
off
in
your
head.
So
I
mean
it
is.
But
you
know
this
is
the
oath
we
swore-
and
this
is
what
we
do
and
we
will
do
it
to
the
best
of
our
ability
for
as
long
as
we
can.
K
But
you
know
we
we
appreciate-
and
we
would
also
like
to
emphasize.
You
know.
At
least
I
would,
from
my
standpoint
as
speaker
as
an
individual,
is
more
emphasis
on
the
fact
that
this
is
a
preventable
illness
and
majority
of
these
deaths
that
we
are
seeing
is
are
preventable,
and
that
is
the
bigger
frustration
you
know.
K
If
for
health
care
workers,
I
think,
at
least
in
my
experience
is
we
get
these
young
sick
patients
who
are
not
doing
well
and
the
disease
is
such
that
beyond
a
certain
point,
we
sort
of
can
anticipate
what
the
outcome
will
be
and
no
matter
what
interventions
you
do.
The
outcome
remains
unchanged
and
it
becomes
very
frustrating
that
you
know,
unlike
other
diseases,
where
you
have
some
degree
of
control
over
the
outcome,
you
can
do
additional
interventions
to
change
trajectory
of
patients
and
this
illness
at
least
with
a
delta
strain.
K
K
By
going
to
some
literature,
you
know
the
the
viral
loads
and
the
nares
are
a
thousand-fold
higher
than
the
wild
type,
which
was
the
original.
You
know
kovitch
strains
and
because
of
that
it
is
rapidly
transmitted,
it
is
it
multiplies
very
fast
and
it
can
overwhelm
even
normal
immunity,
which
is
the
issue
because
so
virulent
multiplies
so
fast
that
even
young,
healthy
patients
who
previously
were
not
the
people
we
were
seeing
in
the
icus.
K
But
now
we
are
seeing
them
because
even
those
people
they
get
a
high
enough
inoculum
are
getting
overwhelmed
by
this
virus
and
and
every
time
to
be
honest,
I
go
out.
You
know
in
public,
and
I
I
see
you
know
people
outside
not
wearing
a
mask
and
you
know
enjoying
their
everyday
lives.
I
feel
I
mean
that's
their
right,
but
it
also
makes
me
concerned
because
I
don't
see
how
there
will
be
an
end
to
this.
K
H
If
I
could
one
other
question,
dr
bhudani,
I
think
a
topic
that's
important
from
a
specialist
like
yourself
to
address.
I
know
there's
a
lot
of
folks
out
there,
who
think
there's
somehow
curative
treatments
for
covid,
and
I
remind
people
that
we
don't
have
cures
for
the
common
cold.
This
is
a
virus.
H
We
try
to
do
things
to
help
support
the
body
as
it
develops
kind
of
a
response
or
a
reaction.
There
are
a
lot
of
people
out
there
who
are
pushing
for
some
of
the
treatments
that
we
see
of
things
like
hydroxychloroquine
ivermectin
people
that
are
proposing
legislation
to
allow
outside
physicians
to
come
in
and
dictate
to
a
hospital
to
allow
people
to
take
that.
H
Maybe
you
could,
I
don't
know
if
you've
had
a
chance
to
review
the
literature
review
studies,
if
you
could
maybe
address
that
topic
briefly,
for
those
who
are
considering
those
people
seem
to
think
that
that
somehow
is
going
to
fix
problems
for
this
if
you've
either
seen
people
that
have
taken
it.
If
you
know
people
that
have
prescribed
it,
if
you
could
perhaps
address
that
issue.
K
K
Medications
that
modulate
the
immune
response
include
the
steroids
and
some
monoclonal
antibodies,
including
the
regeneron
or
tosiluzumab,
which
is
a
medication
that
is
an
antibody
that
that
affects
some
of
the
inflammatory
markers
the
interleukin
6
specifically,
but
those
are
the
best
bets
out
there
and
then
you
try
and
prevent
secondary
injury
patients
who
are
really
sick.
You
give
them
medication
to
modulate
the
immune
system,
and
then
you
prevent
secondary
injury.
You
prevent
fluid
overload.
You
prevent
renal
failure,
you
prevent
secondary
infections
and
you
provide
supportive
care.
K
You
prevent
blood
clots
if
they
end
up
on
a
ventilator.
You
try
and
provide
the
best
ventilator
therapy,
that
is
to
prevent
secondary
injury.
That
is
the
best
we
have
out
there.
There
is
no
medication
in
peer-reviewed
literature
that
shows
that
it
is
effective
as
a
cure
for
this
disease
there
has.
There
was
a
meta-analysis
that
was
published
about
one
of
these
medications
in
the
recent
past.
It
had
to
be
withdrawn
because
some
of
the
databases
that
were
included
in
reaching
those
conclusions
were
either
found
to
be
defective
or
erroneous.
K
So,
as
far
as
I
know,
there
is
no
peer-reviewed
literature
that
shows
any
medication
works
as
a
cure
for
the
disease,
and
you
know,
and
then
that
is
the
the
issue.
In
my
opinion,
we
should
listen
to
the
science,
listen
to
the
experts.
We
have
people
who
have
dedicated
their
lives
studying
infectious
disease
viral
illnesses,
people
are
the
cdc,
the
nih
the
fda.
K
These
are
the
experts
and
we
should
trust
the
science.
It's
kept
us
out
of
trouble
this
long
and
we
should
cross
the
science
and
listen
to
the
scientists
who
spend
their
lives
doing
this
and
if
they
say
we
should
follow
certain
therapies
and
follow
certain
procedures
to
to
reduce
the
death
toll
and
reduce
the
pandemic
burden.
Then
that's
what
we
should
do.
In
my
opinion,.
H
Thank
dr
badani.
I
appreciate
that,
and
I
think
some
of
us
have
argued
that
perhaps
if
we
had
allowed
our
medical
professionals
to
take
the
lead
on
the
messaging
from
the
beginning
in
our
own
state,
we
probably
would
have
had
a
better
response
and
not
quite
of
a
political
nature.
I
know
I've
argued
that
and
we
need
individuals
like
yourself
to
be
able
to
people
front
line
who
are
treating
this
every
day
to
be
able
to
convey
that
message
for
our
members
from
the
kha.
H
I
got
a
couple
of
questions
for
you
as
well.
I
know
you've
talked
that
the
obviously
the
the
nursing
shortage,
the
not
only
just
nurses,
nurses,
aides,
respiratory
therapists,
critical
care
physicians.
You
hear
from
our
doctor
here
today
a
lot
of
people
looking
at
changing
careers.
This
has
been
going
on
a
long
time,
there's
a
lot
of
factors
and
I
can
spend
an
hour
going
through
all
those
factors,
but
you've
mentioned
this
has
been
going
on
for
a
while.
H
We
know
a
lot
of
other
states-
south
dakota,
georgia,
arizona,
arkansas,
texas,
missouri
west
virginia,
just,
I
think,
passed
something
two
days
ago
to
help
with
this
problem.
We
had
a
special
session.
I
made
a
plea
to
the
governor
to
be
able
to
see
if
we
can
do
something
either
to
allocate
more
funds
to
be
able
to
help
with
this
problem
immediately
right
now,
this
has
been
going
on
for
a
while.
Did
you
all
convey
this
message
to
the
executive
branch
and
the
governor
in
the
past
year?
H
I
Yes,
so,
prior
to
the
special
session,
I
think
we
sent
a
recommendation
to
the
house
and
the
senate
leadership,
as
well
as
to
the
administration,
a
proposal
modeled
very
similar
to
the
arkansas
plan,
and
so
yes,
we
have
made
that
request,
and
that
is
the
number
one
thing.
As
I
talk
to
hospitals
all
across
the
state
is
staffing,
and
they
just
tell
me
that
you
know
the
astronomical
amounts
that
they're
paying
it
is
just
not
sustainable,
and
so
any
any
assistance
is
appreciated.
What.
H
I
Well,
as
I've
mentioned,
we
haven't
received
any
additional
federal
provider,
relief
funds
and
the
data
through
just
2020.
We
had
a
billion
dollars
of
losses
that
weren't
covered
by
those
funds.
There
haven't
been
any
more
federal
funds
provided
to
us.
We
certainly
appreciate
this
legislature
passing
our
a
trip
legislation,
but
that
was
money.
Of
course
the
hospitals
put
up
the
provider
tax
to
draw
that
money
down
and
that
was
for
medicaid
and
that,
but
that
has
helped,
but
that
program
ended,
and
you
know
we're
still
waiting
for
cms
to
approve
that
continuation.
I
So
that
was
not
money
for
this.
It
has
helped
the
hospitals,
but
you
know,
I
think
we
felt
like
you
know,
we'd
be
coming
out
of
this
earlier,
but
this
is
drag
dragged
on
and
I
think
what
you
heard
from
the
physician
is
it.
You
know
it
might
be
plateauing,
but
it's
not
it's
not
going
up
and
coming
back
down.
It
is
still
very
high.
Resources
are
strained,
and
hospitals,
large
and
small
hospitals
are
all
saying
that
they
need
help.
I
I
You
know,
there's
always
been
a
number
of
hospitals
that
are
in
poor
financial
assistance
and
there's
financial
help.
There's
there's
lots
of
studies
out
there
anywhere
from
18
to
26.
Hospitals
are
we're
in
poor
financial
condition
before
this
hit.
So
it's
hard
to
say,
I
think,
we're
concerned
about
that
long
term.
H
So
I'll
I
know
I
can
go
flex
it
too
long.
I
talk
too
long
as
it
is
man.
I'm
sure
I
appreciate
the
indulgence.
I'm
gonna
make
one
clean
of
the
camera,
and
hopefully
governor
bashir
is
watching,
because
I
know
governor
beshear
likes
to
communicate
through
television,
and
so
sometimes
we
try
to
make
phone
calls
there's,
not
a
response
or
with
letters
there's
not
a
response
so
governor.
If
you're
watching.
I
made
the
plea
during
special
session,
I'm
making
it
to
you
again.
H
This
group
stands
ready
to
act
on
this
issue.
If
you
need
a
formal
letter
from
me,
but
if
you
want
to
hear
it
directly
through
cameras,
because
I
know
that's
how
we
like
to
communicate,
I'm
asking
you
now
to
call
us
in
a
special
session
to
handle
this
issue
before
we
start
losing
all
of
our
staff,
because
this
isn't
the
last
surge
for
covid19.
H
Another
surge
is
going
to
be
coming
in
the
future
and
if
we
don't
have
staff
that
are
burned
out
or
have
left
or
have
gone
to,
neighboring
states
because
they're
getting
paid
more
we're
going
to
be
stuck
holding
the
bag
in
the
future,
particularly
these
vaccines
that
we're
getting
now
don't
hold
true
for
future
surges.
So
I
would
ask
you
governor:
please
call
us
in
and
allow
us
as
a
general
assembly
to
use
arpa
funds
to
fix
this
problem.
H
A
Thank
you.
I
appreciate
all
of
your
your
sentiments,
senator
senator
alvarado,
and
thank
you
very
much
for
for
this
great
presentation.
We
do
have
a
lot
of
questions
both
for
you
and
for
dr
dr
bhudani.
I
believe
I
just
want
to
quickly
say
you
know
dr
badani,
you
talked
a
little
bit
about
ecmo
and
I
just
want
the
folks
here
to
understand
the
seriousness
of
that
procedure.
That
is
a
labor-intensive
procedure.
A
I
was
on
the
ecmo
team
for
children's
hospital
in
a
neonatal
intensive
care
unit
years
ago,
and
it
took
two
nurses
and
at
least
one
physician
at
the
bedside
constantly
with
this
patient,
and
I
think
another
really
good
point
to
bring
up.
Are
you
know,
while
we're
talking
about
the
cost
of
all
this
and
the
cost
to
the
hospitals
and
the
cost
to
to
to
really
all
of
us
when
we're
talking
about
health
care
costs,
are
you
know,
the
cost
of
a
vaccination
is
about
40.
A
The
cost
of
monoclonal
antibodies
is
probably
in
the
ballpark
of
twenty
four
hundred
dollars,
and
this
is
you
know
if,
if
we
all
had
to
pay
for
this,
so
dr
badani,
do
you
have
any
idea
or
perhaps
nancy
the
cost
of
ecmo
or
the
cost
of
a
typical
intensive
care
unit
stay.
K
So,
as
far
as
I
know
that
the
ecmo
code
cms
reimburses
the
hospital
for
the
drg
code
in
the
in
the
realm
of
about
150
000
for
the
drg
code,
but
you
know
I'm
sure
this
is
going
to
be
additional
money
based
on
the
other
services
that
are
required.
So,
yes,
you're
right
prevention
is
much
better
than
cure.
It's
much
cheaper
as
well
right-
and
this
is
the
most
intensive
therapy
that
can
be
offered
by
any
hospital
any
icu.
K
So
this
is
the
the
most
aggressive
most
intensive
care.
You
can
provide
the
patient
and
it
is
very
expensive.
A
Right
and-
and
it
depends
on
how
long
the
patient
is
is
on
ecmo,
of
course,
and
so
forth,
and
and
that
doesn't
even
include
the
the
rest
of
the
hospital
stay
like
you
said.
So
I'm
going
to
go
ahead
and
move
on
to
questions,
because
we
do
have
a
lot
representative,
dotson.
K
So
from
our
experience,
patients
who
end
up
in
the
icu
critically
ill
about
90
or
more
of
those
are
unvaccinated
right.
Vaccinated
is
single-digit
numbers
and
those
vaccinated
patients
are
usually
patients
who
have
multiple
other
comorbid
conditions
like
cancer,
severe
lung
disease,
renal
failure
and
other
such
issues
who
end
up
with
covid,
and
in
my
experience
I
have
no
data,
but
in
my
experience,
even
those
patients
with
multiple
comorbid
conditions
who
end
up
in
the
icu
with
covet.
They
seem
to
be
faring
better
than
the
young,
healthy
ones
who
are
unvaccinated.
K
So,
in
my
experience,
if
you
are
vaccinated,
you
are
very
much
less
likely
to
end
up
in
the
icu,
which
is
you
know
where
my
experience
lies,
and
even
when
you
do
end
up
in
the
icu,
you
tend
to
fare
better,
even
though
you
may
have
more
comorbid
conditions
or
more
chronic
diseases.
That
would
otherwise
have
made
you
a
worse
candidate
for
survival
right.
B
The
reason
I
ask
that
is
because
I've
seen
numbers
nationally
that
the
recovery
rate
is
relatively
close
on
both
vaccinated
and
unvaccinated.
I
just
wanted
clarity
on
that,
but
I
had
covert
back
in
april
and
so
out
of
curiosity,
I
went
and
took
the
antibody
test.
The
monoclonal
antibody
test,
tested
very
high
and
talking
with
the
pharmacist
that
done
the
test
said
I
you
know,
I'm
in
really
good
shape
after
having
the
the
covid
and
that
really
the
level
I
had
would
rival
the
vaccination
itself.
B
K
So
you
know
I'm
not
an
expert
in
immunology,
but
immunity
from
vaccine
is
not
dependent
just
on
antibody
levels.
Right,
I
mean
a
lot
of
the
immunity
that
you
get
from.
Vaccines
is
dependent
on
what
is
known
as
the
helper
t
cells,
which
are
the
lymphocytes
that
are
sort
of
the
quarterback
for
the
immune
system,
so
antibodies
wane
over
time,
helper,
t
cells
last
much
longer
helper
t
cells,
help,
accelerate
and
exponentially
exponentially
increase
your
immune
response
when
you
do
get
exposed
to
an
antigen
to
which
you
are
vaccinated
against.
K
When
you
get
the
covet
19,
the
covid19
has
multiple
antigens
on
it.
The
antibodies
that
you
develop
are
against
multiple
antigens.
So
a
good
example
is,
you
know
you
got
attacked
by
a
300
pound.
Bear
you
used
your
buckshot
and
you
know
you
hit
it
in
multiple
places
you
killed
the
bear.
That's
good
vaccine
is
the
opposite
vaccine.
You
provide
the
spike
protein
antigen.
K
All
your
antibodies
are
against
that
particular
part
of
the
spike
protein
antigen.
You
are
now.
You
now
have
very
high
immune
levels
against
that
very
important
part
of
the
virus.
So
all
your
immune
effort
and
resources
are
now
directed
the
most
critical
part
of
that
virus.
So
your
chances,
in
my
opinion
and
just
based
on
general
logic,
are
much
higher
to
fight
off
the
delta
variant
or
a
severe
covet
infection
if
you
were
vaccinated
rather
than
if
you
had
natural
immunity.
B
And
that
question
is
really
geared
toward.
You
know
for
the
employee
shortage
that
we
have
the
healthcare
workers
if
they
had
the
had
covered
and
had
high
level
antibodies,
would
that
surpass
suffice
for
them
instead
of
taking
the
vaccine?
So
I
just
wanted
to
ask
that
question.
Thank
you
guys.
C
I
do
and
I'm
chairman
thank
you.
I've
got
two
quick
comments.
One
the
ecmo
procedure
is
it's
an
unbelievable
therapy
process,
particularly
you
have
a
very
very
dear
friend,
who
went
through.
That's
quite
a
few
weeks,
unfortunately,
did
not
make
it,
but
it's
it's
a
good
alternative
to
try
to
get
the
oxygen
back
into
the
system
and
so
forth.
So
it's
very,
very
tough,
and
I
know
it's
very
expensive,
but
that's
sort
of
minor
when
it
comes
to
trying
to
save
somebody's
life.
C
I
want
to
agree
and
back
up
and
support
the
chairman
of
alvarado's
comments
on
pleading
to
the
governor.
This
is
one
of
other
departments
that
I'm
just
saying
that's
a
total
mismanagement
and
rather
upsetting
in
terms
of
how
things
are
handled.
I
have
a
question
for
for
nancy
and
jim.
C
If
you
don't
mind
one
you
mentioned
about
the
court,
the
nurse
has
been
quarantined
and
and
so
forth,
do
you
have
like
a
test
and
stay
procedure
or
if
they're
they've
looked
at
that
it
might
have
been
mentioned
in
the
past,
but
I
don't
recall
it
being
mentioned
in
terms
of
having
that
type
of
approach.
I
I
If
they're
unvaccinated
they've
been
exposed,
they
have
to
be
in
quarantine
for
quite
a
while,
and
as
we
talk
to
our
hospitals,
you
know
there's
lots
of
staff
that
are
off
because
they're
in
one
of
those
situations,
I
think,
if
we
were
at
crisis
standards
of
care,
you
might
be
able
to
have
people
that
are
positive
if
they
don't
have
symptoms
come
back
and
work,
but
that
I
don't
think
we're
at
that
level
and
that
is
not
recommended.
C
Okay,
so
basically,
if
somebody's
exposed
a
nurse
is
exposed,
then
they
would
they
would
continue
to
get
tested
on
a
daily
basis
if
they
don't,
if
they
even
they
just
don't
show
that
are
positive.
They
still
go
into
quarantine.
That's
what
you're
telling
me
is
that
right.
I.
I
C
I
A
Thank
you,
representative
rayburn.
Do
you
have
a
question.
D
D
I
Certainly,
representative
birch
take
your
time.
We
endorse
the
vaccine
and
we
have
worked
very
hard
for
many
months.
In
fact,
when
the
vaccine
came
out,
we
kha
on
its
own,
put
out
public
service
announcements,
encouraging
people
to
get
the
vaccine.
We've
worked
on
two
campaigns
with
kentucky
medical
association,
kentucky
foundation
for
healthy
kentucky,
producing
psas,
and
you
know
taking
it
out
in
in
all
areas
of
the
state,
not
just
in
louisville
but
in
rural
areas.
Highlighting
folks
and
saying
you
know:
why
did
they
get
the
vaccine?
I
D
We
have
six
counties
in
this
state
that
are
the
worst
in
the
nation
and
we
just
passed
some
laws,
this
past
special
session.
That
probably
encouraged
that
to
happen
now.
I
know
that
you
cannot
suggest
to
people
what
they
should
be
doing.
Some
things
we're
at
war,
we're
at
war
with
this
virus
people
are
dying
by
the
end
of
this
year,
there'll
be
more
people
die
from
this
virus
and
died
in
the
first
and
second
world
war
from
casualties
from
from
action.
D
It's
got
to
be
a
a
better
way
of
getting
people
to
do
this.
Here.
When
I
went
in
the
military
they
stripped
us
down
bare,
we
walked
through
a
gauntlet
and
everybody
got
vaccinated.
You
didn't
get
a
choice
you
got
vaccinated,
for
it
was
for
the
common
good
and
that's
what
we
got
to
do
now
is
for
the
common
good
to
do
this
if
we're
going
to
beat
this.
Thank
you,
madam
chair.
A
Thank
you,
representative
weber,.
B
Thank
you,
madam
chair
nancy
and
jim.
Thank
you
all
for
being
here
today.
I
think
you've
given
us
a
lot
of
good
information.
I
do
have
a
couple
of
questions.
I
want
to
begin
with.
With
this
one,
have
any
staff
at
any
of
the
hospitals
or
facilities
that
would
fall
under
your
jurisdiction,
been
terminated
from
their
employment
for
not
getting
a
vaccination.
I
I
believe
there
have
been
some-
and
I
believe,
that's
been
in
the
news
where
staff
have
made
a
decision
not
to
comply
with
a
requirement
that
hospitals
have
put
in
place
to
get
a
vaccine.
Of
course
that's
their
decision,
and
I
think
that
that
has
happened.
Many
of
our
hospitals,
you
know,
give
warnings
first.
So
if
they're,
following
their
existing
policy
of
you
know
you
get
a
written
warning,
you
get
additional
time
and
again,
all
I
can
say
is
in
talking
to
our
hospitals.
I
B
What
would
be
the
percentage
then,
at
this
point,
based
on
what
you've,
what
you've
said
of
employees
at
hospital
staff
who
have
indicated
that
they
are
not
going
to
get
the
vaccination
or
have
not
been
vaccinated?
What
percentage
levels.
I
D
I
do
madam
chair,
thank
you
and
nancy.
I
want
to
thank
you
for
your
testimony.
You
made
a
couple
points
and
I
think,
probably
need
to
be
reinforced.
One
is
that
this
is
not
a
new
issue.
It's
been
there
growing
for
over
a
decade
and
coveted
didn't
cause
it,
but
I
described
it
as
it
pushed
it
off
the
cliff.
That's
certainly
where
we
are-
and
you
also
mentioned
that
if
you
are
providing
an
appropriation
or
hospitals,
are
providing
appropriation
from
the
governor
that
this
just
buys
time.
D
It's
not
going
to
fix
the
problem,
we
need
a
long-term
solution
to
it
and
you
specifically
mentioned
arkansas
and
I
believe
they
committed
245
million
dollars
to
hospitals,
to
help
with
retention
and
recruitment
of
of
staff
and
senator
alvarado's
bill,
which
we
were
not
able
to
hear
senator
bill
8.
I
think
we
asked
for
80
million,
which
is,
I
think,
I'm
a
paltry
amount.
D
Considering
that
our
state
is
a
third
larger
than
arkansas
is,
and
this
is
a
big
big
problem,
and
if
we
are
in
fact
at
war,
then
we
need
the
resources
to
fight
this
battle.
We
certainly
need
it,
and
I
appreciate
the
governor
sending
the
national
guard
to
some
places
throughout
kentucky.
I
don't
think
he's
going
to
be
sending
them
to
litchfield
and
horse
cave
in
in
hardinsburg,
so
we
need
those
resources,
but
the
question
I
have
for
you.
Obviously
a
lot
of
things
have
caused
this.
D
You
may
be
interested
know
that
our
states
kind
of
contributed
this
because,
as
you
know,
I'm
co-chair
of
government
contract
review
and
I
think,
we've
approved
at
least
a
dozen
contracts
for
local
attendance
coverage
for
health
care
professionals,
for
the
state
to
meet
its
health
care
needs.
So
our
state's
been
in
competition
with
the
rest
of
our
state
for
these
scarce
resources,
and
they
have
at
this
time
unlimited
resources
to
do
that
and
that
drives
up
the
cost
and
we
don't
have
that.
D
But
how
much
has
this
problem
been
caused
by
our
schools
not
being
in
session
and
the
unavailability
of
child
care?
Because
again
I
know
this
has
changed
over
the
years
where
you
should
be
normally
a
female
workforce
and
but
is
still
a
strongly
female.
It's
just
driving
a
lot
of
this.
I
I
mean
it's.
Certainly
it
certainly
plays
a
role,
certainly
in
the
very
first
wave.
That
was
a
big
problem
when
the
schools
were
not
open
because
you're
correct
a
lot
of
the
nurses
had
to
stay
home
with
their
children,
and
that
was
a
problem
in
the
first
wave
and
so
what
I
was
hearing
before
the
second
wave
hit
was
you
know.
People
were
very
concerned
about
that.
If
the
school
shut
down
well
number
one,
I
was
hearing
before
this
wave
hit
that
we
hope
another
wave
doesn't
hit
because
we're
going
to
be
short
staffed.
I
We
have.
We
barely
have
enough
nurses
to
cover
what
we're
doing
that's
before
delta,
hit
us
and
then
very
concerned
about.
If
the
school
shut
down,
we
don't
know
what
we're
going
to
do.
So,
it's
a
contributing
factor
along
with
a
lot
of
other
factors,
exhaustion,
nurses,
retiring,
as
we've
heard
my
healthcare
professionals
say
I'm
done
with
healthcare
staff
out
on
quarantine.
It
just
there's
lots
of
factors
that
are
impacting
this.
D
Well
again,
I
appreciate
your
testimony
and
yes,
we
will
beg
our
governor
to
try
to
address
this
issue.
It
can't
be
ignored
any
longer,
but
thank
you,
madam
chair.
A
Thank
you.
Thank
you
all
very
much
for
your
testimony.
I
know
that
you're
probably
going
to
be
hanging
around
for
the
next
one
next
presentation
as
well
before
I
let
you
go.
I
just
have
a
quick
question:
are
there
other
vaccines
that
hospitals
require?
Yes,
what.
I
Are
those
and
how
the
most
common
well
there's?
I
had
a
list
before
I
think
they
look
at
hepatitis,
yeah,
seasonal
flu
for
sure
tb
test,
there's
a
there's,
a
number
of
different
ones:
okay,
okay,.
A
There's
a
number
of
them,
I
thought
so.
Okay.
Thank
you
very
much
all
right,
dr
bhudani.
Thank
you
so
much
for
taking
time
out
of
your
busy
day
and
scheduled
to
be
with
us.
You
are
certainly
welcome
to
hang
on.
If
you
want
to
this
very
exciting
committee
and
discussion.
Actually
we
we
do
think
that
and
but,
but
I
do
thank
you
very
much
thanks
for
all
the
work
that
you
do.
A
Of
course,
thank
you.
Okay.
Next
on
the
agenda,
we
have
the
official
presentation
on
health
care
worker
shortages
and
with
us
we
have
quite
a
few
folks
who
can
make
your
way
to
the
table
and
just
I'll,
let
you
introduce
yourselves.
We
do
have
some
folks
who
are
online
as
well
on
zoom
to
to
be
part
of
this
discussion
cory.
Are
you
the
only
one
here
in
person.
A
All
right,
if
you
all,
could
just
introduce
yourselves
and
and
we'll
let
the
folks
online
do
the
same
and
proceed
with
your
testimony.
M
A
L
N
And
I'm
donna
meador
with
the
kentucky
nurses
association
coming
in
through
zoom.
A
Okay,
thank
you.
Welcome
to
everyone.
Thank
you
for
being
here,
and
I
know
we
talked
a
little
bit
in
the
last
presentation
about
some
of
the
short-term
fixes
and
some
of
the
problems
that
we're
seeing
in
terms
of
attrition
and
hopefully
we're
going
to
tap
into
some
of
those
long-term
solutions
that
we
need
to
be
thinking
about.
So
thanks
for
being
here.
L
M
M
Before
we
talk
about
some
of
the
conversations
that
we're
having
it's
probably
helpful
to
talk
about,
how
did
we
get
here-
and
there
are
multiple
reasons
that
and
and
things
that
have
caused
this
shortage.
But
let
me
just
talk
about
a
few
lack
of
graduate
medical
education
or
gma
funding.
M
Residency
training
slots
have
not
increased,
leaving
hundreds
of
medical
students
across
the
country
without
a
slot
for
residency
training.
Each
year,
current
federal
law
caps,
the
number
of
federally
funded
residency
training
positions,
freezing
the
number
of
available
to
that
which
it
existed
in
1996..
M
Unfortunately,
congress
has
failed
to
respond
for
many
years.
I
know
there's
some
current
efforts
happening
right
now,
where
they're
trying
to
fix
that
problem,
but
because
of
the
inaction
it
has
led
to
greater
gaps
between
the
number
of
physicians
that
we
have
versus
the
number
of
physicians
that
we
need.
There's
also
increasing
debate,
patient
demand.
M
So
it
stands
to
reason
that
this
situation
will
become
even
more
severe
as
our
population
grows
ages
and
continues
to
suffer
from
poor
health
and
when
you
add
a
greater
number
of
insured,
which
is
a
good
thing.
You
still
have
even
more
individuals
seeking
physicians
and
it's
not
just
our
patient
population
that
is
getting
older.
M
M
You've
heard
it
reference,
and
I
want
to
touch
upon
the
the
physician
burnout
issue
with
a
majority
of
american
physicians
experiencing
some
sign
of
burnout.
It
is
a
condition
that
affects
all
specialties
in
all
practice
settings.
Clearly,
covid
has
been
a
major
source
of
this
of
such
burnout
recently,
but
these
career
fatigue
or
resiliency
issues
that
we've
talked
about
are
years
in
the
making.
In
addition
to
covet,
burnout
is
often
associated
with
increasing
administrative
responsibility
due
to
regulatory
pressures
and
evolving
payment
and
care
delivery
models.
M
You
here's
to
oftentimes
talk
about
prior
authorization
and
things
like
that.
That's
what
we're
talking
about
when
we
say
administrative
responsibilities
and
barriers,
these
types
of
things
can
lead
to
reduction
in
the
amount
of
time
that
physicians
spend,
delivering
direct
patient
care
and
when
a
physician
is
burned
out,
it
can
have
a
significant
impact
on
organizational
productivity,
morale
cost
and
the
quality
of
care
being
delivered.
M
You
have
to
understand,
premiums
differ
by
state
and
it
is
a
factor
that
can
truly
influence
a
physician's
decision
about
where
he
or
she
locates
their
practice,
and
we
know
that
medical
liability
insurance
premiums
have
begun
an
upward
trend
after
more
or
less
holding
steady
after
the
past
decade,
and
this
is
according
to
new
analysis
from
the
american
medical
association
in
2020.
During
the
height
of
the
coven
19
pandemic,
more
than
30
percent
of
premiums
reported
on
a
medical
liability
monitor
national
survey
of
liability.
Insurers
increased
from
the
previous
year,
the
highest
percentage
since
2005..
M
M
The
ama
report
underscores
the
need
for
tort
reform
in
kentucky.
These
are
just
a
few
examples
of
some
of
the
root
causes
and
the
contributing
factors
to
our
shortages
over
the
course
of
many
years.
But
how
bad
is
the
shortage
shortages
impact
every
specialty?
In
fact,
at
a
meeting
of
a
severe
mental
illness
task
force?
I
think
earlier
this
summer
we
heard
about
the
extreme
shortage
of
psychiatrists
for
our
state,
but
it's
not
just
psychiatrists.
M
There's
a
white
paper
that
was
generated
by
dr
kevin
pierce
and
his
team
at
the
university
of
kentucky
a
few
years
back,
obviously
pre-coveted
that
analyzes
the
primary
care
workforce
simply
looking
at
primary
care.
Physicians,
who
include
family
medicine,
internal
medicine,
pediatrics
and
geriatric
medicine,
physician
kentucky
ranks
43rd
in
the
country
for
the
number
of
primary
care.
M
Physicians
per
100
000
population,
according
to
the
white
paper,
kentucky
produces
and
retains
about
55
new
primary
care
physicians
per
year
and
has
to
recruit
55
to
60
more
from
out
of
the
state
with
those
two
numbers
combined,
which
is
about
110
to
115.
That
is
short
of
the
124
primary
care.
Physicians,
that
the
paper
states
that
we
should
produce
annually
just
to
keep
from
worsening
the
shortage
to
actually
achieve
the
u.s
median
within
the
next
decade.
We
would
have
to
add
246
primary
care.
M
Physicians
per
year,
we
are
consistently
falling
behind
the
kma,
along
with
other
stakeholders.
You
heard
from
kha
the
primary
care
association
and
others
we've
been
talking
and
having
this
conversation
for
many
years,
but
obviously
given
where
we
are
now,
we've
increased
that
dialogue
and
we
want
to
be
offering
to
you
concrete
solutions
on
how
to
fix
this
problem.
So
I
want
to
assure
you
those
conversations
are
happening.
They
will
continue
and
they
will
get
ever
more
frequent
with
each
of
you.
M
But
some
of
the
ideas
that
have
been
thrown
up
that
you've,
probably
heard
about
in
the
past-
and
you
should
probably
get
used
to
hearing
about-
is
greater
number
of
residency
slots.
Increased
funding
for
loan
forgiveness
tax
credits
for
preceptors,
which
I
know
both
of
our
chairs
of
this
committee-
have
has
filed
legislation
in
the
past.
Addressing
that
initiatives
to
address
physician-
and
I
won't
just
say,
physician
burnout-
I
hope
other
practitioners
will
allow
me
to
speak
on
their
behalf,
that
it's
burnout
for
all
healthcare
practitioners
and
then,
as
I
mentioned,
liability
reforms.
M
M
Physicians
in
kentucky
are
a
major
driver
of
the
state
economy,
spurring
economic
growth
and
creating
jobs
across
all
industries,
kentucky
physicians,
they
hire
locally,
they
buy
locally
and
they
support
the
local
economy
and
through
the
creation
of
jobs,
with
strong
wages
and
benefits
paid
to
workers
across
the
state.
Physicians,
empower
a
high
quality,
sustainable
workforce
that
generates
state
and
local
tax
revenue
for
community
investments,
positions,
economic
output
or
the
value
of
the
goods
and
services
that
they
provide,
helps
other
businesses
grow
through
their
own
purchasing
and
through
the
purchasing
of
their
employees.
M
M
M
So
clearly,
there
is
a
true
and
significant
return
on
investment
health-wise
and
economically,
when
we
attract
and
retain
physicians
to
the
commonwealth
during
the
special
session
and
through
today's
hearing,
kma
is
very
encouraged
that
many
legislators
recognize
this
as
an
issue
and
have
urged
action
and
the
association
stands
ready
with
you,
members
of
the
kentucky
general
assembly
now
and
through
the
2022
legislative
session
and
beyond.
If
necessary,
to
address
this
vexing
issue
again
with
long-term
policy
solutions
again,
thank
you
to
the
chairs
and
the
committee.
A
Thank
you
very
much.
I
think
at
this
point
I'm
going
to
invite.
We
have
dr
jacqueline
bitterman
and
donna
meter
with
the
kentucky.
A
Well,
actually,
excuse
me,
the
kentucky
nurses
association,
donna
meter:
do
you
want
to
try
to
tag
team
it
a
little
bit
with
the
kma
and
talk
about
the
nursing,
the
shortage
from
the
nursing
perspective,
nurses,
association.
H
N
Thank
you
good
afternoon,
I'm
donna
meador,
I'm
the
president
of
the
kentucky
nurses,
association
and
I've
been
a
registered
nurse
in
kentucky
for
39
years,
k
a
represents
and
speaks
for
the
90,
000
nurses
in
kentucky
in
all
levels
of
nursing
and
practice
and
nurses
represent
a
reminder
53
of
all
health
care
workers.
N
Nationally,
I
come
to
you
today
representing
the
k
a
because
we
are,
as
as
most
of
you
are
very
concerned
about
staffing
shortages
in
the
overall
health
and
well-being
of
our
nursing
workforce
and,
as
has
been
said
before,
this
is
not
a
new
nursing
shortage.
We
have
been
in
a
nursing
shortage
before
the
pandemic,
so
this
is
sort
of
an
acute
on
chronic
kind
of
a
situation
already
in
the
nursing
workforce
shortage,
and
this
has
extremely
exacerbated
the
problem
so
pre
pandemic.
N
Some
findings
from
georgetown
university
were
that
23
of
nurses,
55
and
older
plan
to
either
leave
nursing
or
reduce
their
volume
of
clinical
work
and
that
the
nursing
workforce
will
be
facing
a
shortfall
of
roughly
200
000
nurses
by
2020..
A
kentucky
example
that
was
pre-pandemic
was
one
of
our
large
health
systems.
N
Our
current
shortage
data,
which
you've
heard
some
of
already.
As
you
know,
nearly
650
thousand
kentuckians
have
tested
positive
for
covid.
The
vast
majority
of
coveted
patients
that
are
pushing
hospitals
past
the
brink
are
unvaccinated
available.
Data
shows
that
1.1
percent
of
coveted
hospitalizations
are
people
who
are
fully
vaccinated,
so
a
very,
very
small
percent.
N
So
we
know
that
we're
facing
a
dangerous
capacity,
dangerous
capacity
levels
at
our
hospitals,
you've
heard
that
from
nancy
nearly
70
percent
of
our
kentucky
hospitals
currently
face
critical
staff
shortages,
and
all
this
has
a
direct
impact
on
the
largest
segment
of
healthcare
workers.
Nurses,
according
to
wk
in
northern
northwestern
or
northeastern
kentucky
western
west
virginia
and
southern
ohio
on
september
19th.
The
fourth
wave
of
coca-19
is
exacerbating
the
ongoing
crisis
for
the
nursing
work
workforce
and
has
led
to
burnout
for
many
nurses.
N
As
a
result,
many
are
putting
their
jobs
in
substantial
numbers
all
across
the
country,
with
62
percent
of
hospitals
reporting
a
nurse
vacancy
rate
higher
than
7.5
percent,
and
that's
according
to
a
2021
nsi
nursing
solutions
report.
But
the
plan
pandemic
is
also
worse
in
problems
that
have
long
existed
within
the
nursing
profession,
in
particular,
widespread
stress
and
burnout,
health
and
safety
issues,
depression
and
work-related
post-traumatic
stress
disorder
and
even
an
increased
risk
of
suicide
over
the
regular
general
population.
N
In
addition,
nurses
need
to
contend
with
growing
workloads
and
inadequate
staffing
or
not
having
the
right
number
of
nurses
on
the
right
units
to
ensure
that
patients
receive
safe
quality
care.
Mandatory
overtime
is
another
challenge
and
occurs
when
nurses
must
work
extra
hours
beyond
their
shift
because
of
staffing
shortages.
All
of
these
issues
can
lead
to
low
job
satisfaction
among
nurses
and
are
likely
to
contribute
to
nurses,
leaving
the
profession,
a
trend
that
began
well
before
the
current
pandemic
struck.
N
According
to
my
colleague
at
the
kentucky
high
school
association,
deb
campbell
nurses
make
up
the
largest
shortage
among
health
care
professionals.
Many
have
retired,
some
have
left
the
bedside
because
of
the
pandemic.
From
a
recent
kha
survey,
just
under
5
000,
open
clinical
positions
exist
in
kentucky
and
about
two-thirds
of
those
are
nurses,
and
so
across.
The
state.
N
Retired
nurses
are
being
asked
to
return
to
the
to
the
profession,
which
is
actually
there
are
some
innovative
strategies
involving
that
nurses
are
leaving
kentucky
to
pursue
travel
nursing
in
other
states
where
they
can
make
150
to
200
an
hour
along
with
50
bonuses,
so
they
are
making.
They
can
make
five
to
six
digit
salaries
over
a
time
frame
of
about
13
weeks,
what's
happening
in
kentucky
mirrors
this
national
emergency.
N
On
september
1st,
the
american
nurses
association
contacted
the
department
of
health
and
human
services
encouraging
immediate
and
robust
action
to
address
the
unsustainable
nursing
shortage
facing
the
country.
According
to
a
survey
from
trusted
health,
the
coca-19
pandemic
has
caused
39
percent
of
nurses
aged
20
to
39,
to
report
that
their
commitment
to
nursing
has
decreased.
N
N
So
our
parent
organization,
the
american
nurses
association,
recommends
some
positive
steps
addressing
the
fatigue
and
mental
well-being
of
nurses,
developing
strategies
to
retain
the
current
workforce,
addressing
barriers
to
practice
faced
by
nurses,
addressing
the
persistent
barriers
that
limit
the
number
of
qualified
nursing
students
that
can
be
educated
each
year,
a
little
closer
to
home.
Our
kentucky
nurse
leaders
recommend,
as
mentioned
previous
by
speakers,
funding
to
hospitals
and
long-term
care
organizations
to
retain
retrain
and
recruit
nurses,
loan
forgiveness
programs.
N
The
kentucky
nurses
association,
along
with
other
nursing
professional
organizations
such
as
the
kentucky
organization
of
nurse
leaders,
we
will
continue
to
provide
programs
to
enhance
mental
health
and
resiliency,
which
we've
been
doing
since
basically,
the
beginning
of
the
pandemic,
identify
and
promote
innovative
care
models
to
maximize
nursing
and
other
health
care
professionals
that
are
still
in
the
workforce
and
still
provide
safe,
high-level
quality
patient
care.
N
And
then
there
are
some
other
innovative
programs
which
we
are
promoting,
such
as
a
nurse
amaritis
program
where
maybe
you
bring
back
nurses
from
retirement
at
a
lesser,
a
lot,
a
shorter
shift
and
more
inclined
to
what
their
specialty
was
to
assist
the
nurses
that
are
on
the
floor,
better
use
and
more
use
of
nurse
externs,
and
these
are
nursing
students
in
their
final
segment
of
education
prior
to
graduating
and
taking
the
state
boards.
Some
blended
staffing
models,
which
are
kind
of
enhanced
version
of
the
old
team
nursing.
N
So
we
have
actually
tested
and
vaccinated
hundreds
of
patients,
if
not
thousands,
and
particularly
in
the
louisville
area,
but
in
we've,
assisted
with
that
throughout
the
state
k
k.
A
also
will
be
surveying
the
90
000
nurses
in
kentucky
to
get
more
information
about
why
they
may
be
leaving
the
profession
or
thinking
about
leaving
the
profession
where
the
pain
points
really
are
and
what
they
need.
N
Late
in
2020,
you
met
guys
may
not
know,
but
in
2020
the
world
health
organization
designated
that
as
the
year
of
the
nurse
it
was
actually
the
200th
anniversary
of
florence
nightingale's
birthday
in
late
1920,
late
2020.
They
extended
that
through
2021,
so
it
is
still
the
year
of
the
nurse.
N
We
need
to
keep
recognizing
the
nurses
as
the
heroes
that
they
are
and
the
other
healthcare
workers
that
are
out
there
as
the
heroes
that
they
are,
because
it
is
the
patients
who
suffer
when
there
aren't
enough,
especially
when
there
aren't
enough
nurses.
So.
A
Well,
thank
you
very
much.
That
was
a
very
great
detailed
report
and
presentation.
I
I
really
appreciate
the
work
that
is
being
done
on
behalf
of
nurses
by
the
kentucky
nurses
association.
So
thank
you
for
planting
those
those
great
seeds
and
and
great
thoughts.
We
we
really
need
to
work
together,
and
I
know
that
the
hospital
association
has
put
together
a
healthcare
workforce
work
group
and
are
partnering
with
with
many
of
the
folks
here
today.
So
I
just
want
everyone
to
know
that
that
is
going
on.
A
This
is
something
you
know.
Certainly
we
have
a
short-term
problem
right
now.
We,
we
absolutely
have
a
long-term
problem
and
we
do
need
to.
We
need
to
really
hone
in
on
some
of
these.
These
points
that
have
been
discussed
today
and
I'm
very
glad
to
have
folks
from
kctcs
here
today.
Certainly
kct
kctcs.
Excuse
me.
I
can
say
this
is
a
great
great
partner
across
kentucky.
We
have
many
nursing
schools
and
other
programs
that
train
our
health
care
workers,
nurses,
respiratory
therapists
and
so
forth.
A
So
I
don't
want
to
lead
people
to
to
believe
that
kctcs
is
the
only
provider
of
this
education,
but
we
really
appreciate
all
that
you're
doing-
and
I
I
wanted
you
here
today,
because
I
know
that
there
are
some
great
partnerships.
In
fact,
I
was
at
gateway
up
in
northern
kentucky
yesterday
and
we
talked
a
great
deal
about
this
healthcare
worker
shortage
and
some
of
the
innovative
programs
that
they're
putting
together.
So
I
wanted
you
here
to
talk
about
how
we
move
forward
out
of
this
dilemma.
L
L
We
are
your
your
community
college
system
based
on
our
legislative
mandate
through
krs
164.
Our
mission
is
to
improve
the
quality
of
life
and
employability
of
kentuckians.
We
offer
115
different
technical
programs
outside
of
our
direct
transfer
programs.
95
percent
of
those
115
are
technical
and
we
are
an
open
access
institution.
L
We
have
a
different
student
population
than
your
public
universities.
Our
students
tend
to
be
more
first
generation,
meaning
they
have
no
one
at
home
to
perhaps
help
them
through
the
idiosyncrasies
of
getting
into
college.
They
tend
to
be
less
prepared
for
college
they're
older,
they
have
children
and
they
earn
less
money
or
come
from
less
resourced
households.
L
What
what
is
a
credential?
We
want
to
take
just
a
minute
and
let
you
all
know
that
we
offer
stackable
credentials,
so
somebody
can
come
in
and
get
that
say
nurse
aid
certificate,
for
example,
they
can
go
and
work,
but
then
they
can
come
back
and
they
can
move
towards
a
diploma
or
towards
an
associate
degree
or
perhaps
all
three.
So
most
of
our
associate
degree.
Programs
do
have
certificates
that
allow
the
individual
to
go
right
to
work
and
then
keep
working
while
they
are
moving
through
their
their
continuing
their
education.
L
We
use
a
lot
of
ways
to
bring
students
in
we
recruit
students
via
social
media
through
our
web
presence
and
targeted
searches.
If
you
search
in
google,
for
example,
you
may
pull
up
a
college
as
your
first
opportunity.
We
invite
students
into
new
careers
through
a
number
of
ways.
This
particular
website
is
an
example
of
a
targeted
outreach
program
that
is
focused
on
displaced
workers,
so
a
person
who
is
thinking
about
a
career
change
or
expanding
their
current
career
coming
back
to
work.
L
We
also
do
multiple
outreach
events
at
high
schools
at
places
of
business
and
through
special
events
such
as
owensboro
community
and
technical,
college's
experience
nursing
day
where
they
open
their
program
on
the
weekend,
and
people
can
come
in
and
spend
a
couple
of
hours
understanding.
What
being
a
nurse
means,
what
the
educational
path
is,
the
salary
the
opportunities
and
maybe
explore
the
simulators
and
some
of
the
other
teaching
equipment.
L
76
percent
of
our
students
receive
some
type
of
financial
aid
and
68
of
our
technical
programs,
including,
obviously,
our
health
care
programs
fall
under
the
five
work,
ready
scholarship
sectors
and,
as
you
can
see,
healthcare
is
taking
the
lead
in
terms
of
the
number
of
participants,
and
we
are
grateful
to
the
legislature
for
your
continuing
support
of
these
scholarships
separately.
We
also
partner
with
employers.
L
We
support
companies
investing
in
their
workforce
by
offsetting
the
cost
of
kctcs
training
by
up
to
75
percent
through
legislatively
directed
funds
that
are
go
through
our
budget
and
we
call
them
trains
funding.
A
great
example
of
this
is
at
ashland
community
and
technical
college,
where
many
smaller
long-term
health
care
facilities
get
together
and
put
their
employees
in
training,
and
then
that
training
is
offset
by
75,
so
the
employers
do
not
have
to
pay
as
much.
L
We
offer
a
number
of
medical
associate
degrees
or
healthcare
associate
degrees
and
information
on
that
is
in
some
materials
we
brought
to
you
today
printed
materials.
We
also
provided
them
digitally,
and
the
information
includes
the
information
on
those
degrees
are
diplomas
and
certificates,
including
the
number
of
graduates
for
the
last
three
years
and
their
wages.
L
Last
year,
in
2020,
2021
kctcs
awarded
8598
healthcare
credentials
to
6886
graduates,
and
we
know
that
in
general,
at
least
70
percent
of
our
graduates
stay
in
kentucky
and
are
employed
by
kentucky
companies.
Many
live
in
kentucky,
but
maybe
go
across
the
state
border
to
work
in
a
nearby
location
or
nearby
city.
L
A
recent
council
on
post-secondary
education
return
on
higher
education
investment
report
notes
that
across
all
fields
for
the
class
of
the
high
school
graduating
class
of
2011,
they
earned
more
money
when
they
had
some
higher
education,
a
certificate
diploma
or
associate's
degree,
and
did
that
high
school
student.
Eight
years
later,
since
kctcs
tuition
is
around
half
that
of
our
universities,
they
were
also
in
the
workplace
faster
with
our
certificates
and
degrees
and
at
less
cost.
L
We're
really
excited
to
be
looking
forward
to
the
opportunity
to
partnership
with
the
kentucky
hospital
association.
We
also
are
a
supporter
of
the
kentucky
chambers
workforce,
the
kentucky
chamber,
workforce,
center's
talent,
pipeline
management
program,
which
pulls
together.
Employers
to
look
at
specific
job
needs
across
a
variety
of
employers
in
a
region
and
then
attempts
to
work
with
educational
partners
to
meet
those
needs.
L
Currently,
there
are
eight
tpm
healthcare
collaboratives
involving
49
employers
across
the
state
they're
evaluating
61
positions,
critical
to
their
industry
and
to
their
success
with
over
12
000
projected
openings
statewide
through
those
collaboratives.
The
kentucky
chamber.
Workforce
center
has
seen
some
specific
barriers
in
these
pipelines
and
that
can
include
child
care
issues,
food
insecurity,
low
wages
and
some
positions,
internet
access
and
more-
and
we
certainly
see
those
barriers
as
well
for
our
students,
but
for
our
colleges
and
our
students.
L
We
have
other
barriers
as
well,
you've
heard
about
the
high
cost
of
nurses
to
the
health
care
facilities,
but
we
are
also
competing
for
those
nurses
when
they
are
the
faculty
in
our
nursing
program,
and
the
same
goes
for
many
of
the
other
health
care
opportunities
we
compete
with.
There
are
many
providers
it
takes
all
of
us
to
meet
kentucky's
needs,
but
we're
also
all
competing
for
clinical
sites
and
wanting
to
ensure
our
students,
those
appropriate
offerings.
L
L
They
also
can
take
two
layers
of
or
two
years
of
classes,
on
top
of
that
layer
on
top
of
their
degree
and
get
to
their
bachelor's
degree
again,
while
they're
working.
So
I'm
going
to
ask
dr
bitterman
to
speak
to
a
couple,
or
at
least
one
of
jctc's
innovative
nursing
programs,
particularly
their
apprenticeship
program,.
L
B
Okay,
so
we
were
approached
by
one
of
our
long-term
care
facilities
to
be
able
to
increase
their
pipeline
of
nurses,
and
so
we
have
started
an
lpn
apprenticeship
at
the
carrollton
campus,
where
someone
will
go
from
a
nursing
to
a
licensed
practical
nurse
in
one
year
with
a
flexible
schedule
and
so
to
meet
the
needs
of
our
health
care
partners.
B
Another
opportunity-
that's
happened
at
jefferson
that
I'm
we're
really
proud
of
as
well.
Is
we've
opened
an
evening
hybrid
option
for
the
registered
nurse
program
at
shelby
county
campus?
This
was
financially
supported
by
four
of
our
healthcare
partners
and
matched
by
the
governor
reserve
fund
to
allow
that
to
happen.
This
is
an
evening
program
again,
our
lectures
are
online.
B
Students
can
watch
them
when
they
are
available.
We
provide
one-on-one
tutoring
services
as
needed,
and
then
they
come
to
class
for
lecture
and
clinical,
and
this
really
has
contributed
to
the
workforce
needs
of
our
region
and
allowed
our
students
to
have
flexibility
in
what
they
need
to
complete
their
degrees.
B
So
that
is
the
one
in
carrollton
that
I
mentioned
trilogy
healthcare
is
the
one
that
partnered
with
us
to
do
that,
and
so
their
students
work
no
more
than
25
hours
a
week
and
then
come
to
our
campus
for
lecture
environments.
Sorry
lab
and
clinical
to
complete
that
and
they
do
get
credit
towards
their
skills
that
they
complete
while
they're
at
work.
So
we
do
allow
some
test
out
of
different
types
of
skills
that
they
can
demonstrate,
while
they're
working.
L
L
Kctcs
receives
many
fewer
dollars
per
student
than
any
of
the
universities,
and
yet
our
60
colleges
are
providing
that
skilled
workforce
that
you
all
are
calling
for
today
and
our
students
are
getting
in
that
workforce
much
more
quickly.
We've
listed
a
few
of
our
funding
priorities
on
this
slide
and
you
also
hopefully
receive
the
handout.
That's
our
competitive
workforce
investment
initiative
and
we're
asking
that
you
consider
that,
as
a
way
to
help
all
16
colleges
meet
needs
across
the
commonwealth.
L
A
Thank
you
so
much
for
being
here.
I
I
just
find
it
fascinating.
Listening
to
you
and,
and
I'm
just
always
impressed
by
by
all
of
these
groups,
but
you
know,
kctcs
has
really
come
to
the
table
with
some
innovative
and
and
creative
programs.
A
I
love
you
know
the
common
sense
approach
to
creating
those
career
pathways
and
working
with
other
universities
and
and
certainly
our
providers.
So
obviously
we
have
all
of
the
right
people
at
the
table
to
discuss
this
issue.
A
We've
got
a
long
list
of
things
that
that
we
can
work
on,
and
certainly
I
would
encourage
all
of
my
my
colleagues
here
to
visit
their
local
community
colleges
and
and
really
take
a
tour,
see
what
they're
all
about
and
see
how
we
can
support
them,
because
I
came
away
with
some
ideas
yesterday
and
we'll
we'll
continue
working
on
those.
We
do
have
a
couple
of
questions.
I
know
that
co-chair
alvarado
would
like
to
say
something.
First.
H
Thank
you,
madam
chair,
and
and
thank
you
to
the
k,
a
kma
kctcs
for
coming
today.
This
is
great
there's
a
lot
of
members
that
we
have
on
this
committee
in
the
general
assembly
that
have
have
probably
less
than
four
years
of
experience,
and
this
has
been
a
topic
that,
like
we
said,
has
been
out
there
for
a
long
time.
I'm
gonna
throw
something
out
that
maybe
the
members
would
want
to
write
down,
because
I've
mentioned
it
before
when
I've
filed
other
bills.
H
It's
a
deloitte
study
that
was
done
here
in
the
state
of
kentucky.
It's
entitled,
the
commonwealth
of
kentucky
healthcare
workforce
capacity
report
came
out
in
may
2013.,
it's
an
85-page
report.
It
looks
back
in
2013
with
the
number
of
physicians,
nurses,
nurses,
aides,
you
know
there,
you
can
go
through
it's
an
entire
report
on
this
and
then
recommendations,
because
people
are
saying
well,
we
should
put
together
a
workforce
to
figure
out
what
we
got
to
do
to
help
retain
workforce.
H
H
To
get
done,
we
got
one
passed
only
to
have
our
supreme
court,
throw
it
out
the
window
and
say
it
was
unconstitutional,
so
there's
other
methods
of
getting
some
of
those
things
done,
but
I
would
encourage
the
members
to
review
that
report
because
it's
been
out
there
at
least
for
eight
years,
it'll
be
nine
years
when
the
next
session
comes
into
place
and
if
we
just
adopt
it,
I
think
the
majority
of
most
of
those
things.
H
H
Again,
you
can
have
all
the
tubes
hospital
beds,
you
know
pills
whatever
you
think
constitutes
health
care.
Health
care
is
ultimately
people
providing
a
service
to
other
people,
and
if
you
don't
have
those
people
that
know
how
to
deliver
those
treatments
and
those
medications,
you
don't
have
health
care
and
our
nurses
in
particular
our
doctors,
are
the
lifeblood
of
our
health
care
system
and
we're
hemorrhaging
and,
like
I
said,
on
the
flee
of
the
day,
all
bleeding
eventually
stops
it's
a
statement.
H
We
say
in
health
care:
either
the
patient
passes
away
or
you
manage
to
stop
the
bleeding
we're
in
a
critical
situation.
We're
pretty
anemic.
We've
got
to
do
something
to
help
with
this.
So
I
appreciate
all
of
your
thoughts.
I'd
encourage
members
to
review
that
capacity
report.
Thank
you,
madam
chair.
A
Thank
you.
Maybe
we
can
share
that
with
everyone
representative
parente.
F
F
My
questions
are
for
corey
and
you
may
not
be
able
to
answer
this
question.
You
know
my
husband's
in
in
a
physician
and
he's
currently
on
the
faculty
of
the
uofl's
on
owensboro
health,
family
medicine,
residency
program,
trying
to
get
more
family
practice,
but
personally
I've
seen
issues
with
medical
education.
I
mean
it
seems
like,
and
I
could
be
wrong
and
others
could
correct
me,
but
it
seems
like
some
of
the
and
it
may
be
a
cultural
thing,
but
sometimes
it
seems
like
the
younger
ones
coming
out.
F
They
don't
want
nine
to
five,
don't
want
to
see
in
the
hospital
don't
see
after
hours.
Is
there
any
way
that
medical
education
what's
going
on
with
medical
education?
Where
did
hospitals
come
from?
My
husband
was
one
that
he
he
was
a
family
physician.
He
wanted
to
see
you
if
you
were
in
office
in
the
hospital,
it's
like
where's
that
going
and
then
the
other
thing
like
he
told
me
once
if
some
of
the
new
ones
see
six
or
eight,
they
think
they
worked
hard
and
I
said:
are
they
that
lazy?
F
M
Well,
I
I
certainly
don't
have
any
empirical
data
to
back
this
up,
but
I
do
talk
to
a
lot
of
doctors.
We
have
five
to
six
thousand
members
across
the
state,
and
so
I
have
a
lot
of
conversations.
So
I'm
speaking
anecdotally-
and
I
do
think
there
is
an
element
of
that
is
there's
cultural
changes.
M
Physicians,
nurses
and
other
healthcare
practitioners
have
many
of
them
have
made
a
decision
that
I
want
more
stable
work
hours.
I
want
to
spend
more
time
with
family
and
that's
all
legitimate,
and
but
I
do
think
that
we're
seeing
that.
I
do
think
that
the
the
real
burden-
and
I
didn't
get
into
a
lot
of
details
about
it-
is
really
about
the
administrative
burden,
the
ehr,
the
prior
authorization.
M
These
rules
that
have
been
put
in
place
that
may
have
been
very
well
intended,
but
are
not
getting
the
kinks
worked
out
now
after
many
many
years,
and
so
I
think
that
we
we've
tried
to
pass
some
legislation.
We
passed
some
prior
authorization
legislation,
dr
alvarado
and
representative
mosher.
I
think
many
of
you
on
this
committee
were
very
influential
in
that
I
think
we
have
to
continue
to
identify
those
administrative
barriers
to
help
streamline
the
the
provision
of
health
care.
M
I
I
heard
a
doctor
tell
me
once
and
I've
never
forgotten
it
when
he
told
me
this.
He
says
I
miss
when
the
practice
of
medicine
was
a
profession
and
not
a
job,
and
that
has
always
stuck
with
me
because
what
he
was
referring
to
is-
and
we
know
healthcare
is
a
business
but
a
lot
of
the
the
business
aspects
not
being
able
to
streamline
that
and
make
it
more
efficient,
and
many
of
these
things
were
meant
to
be
more
efficient
right.
M
Ehrs
electronic
health
records
were
meant
to
be
effect
efficient,
but
as
the
federal
and
state
government
get
more
involved
in
the
provision
of
health
care,
there's
more
rules,
there's
more
dollars
involved.
That
means
that
there's
more
rules
more
strings
attached.
Well,
that
also
means
administrative
burden,
and
we've
got
to
get
very
serious
about
streamlining
that
out,
so
that
they
don't
get
burned
out.
They
want
it
to.
It
goes
back
to
being
a
profession
and
not
a
job.
I
I'm
sorry.
F
Thank
you
and
senator
you
talked
about
when
I
looked
at
you
yesterday
when
they
were
talking
about
prior
authorizations
and
I'm
going
to
text
email,
my
federal
reps
about
the
gme
slots
and
whatever
we
can
do
there
and
I'm
I'm
willing
to
stand
with
this
committee
do
whatever
work.
We
need
to
do
to
help.
So.
Thank
you
all
thank.
E
Thank
you,
madam
chair,
and
I
appreciate
each
of
you
coming
and
and
testifying
today
a
lot
of
good
information.
You've
shared
with
us,
I'm
going
to
talk
about
a
situation
that
happened
in
in
my
southeast
kctcs
last
year,
as
they
were,
having
conversations
with
hospitals
and
providers.
You
know
there
was
obviously
it
was
iterated.
There
was
a
need
for
more
nurses,
and
so
they
they
started
planning
for
that
in
november,
and
they
submitted
for
an
increase
of
15
nurses,
which
has
to
go
before
the
board
of
nursing
and
get
approved.
E
They
got
denied
on
january,
2nd
to
increase
their
their
nurses
in
their
program
by
15..
They
appealed
it.
They
were
denied
again
in
february,
and
we've
not
been
able
to
do
so.
Basically
because
the
board
of
nursing
has
said
no,
they
cited.
They
cited
two
issue,
two
issues
in
their
original
reason:
they
they
they
denied
it.
I
guess
and
southeast
gave
them
the
information
said
you
know.
Y'all
should
not
deny
this.
We,
you
know
our
retention
rates
are
over
60
percent.
I
think
that
was
one
of
the
major
issues.
E
Are
you
all
seeing
that
was
that
a
one-off
instance
from
the
board
of
nursing
or
are
y'all
seeing
that
across
the
board,
as
we
try
to
to
make
sure
we
have
good
nurses,
you
know
getting
the
training
they
need
to
address
this
problem.
If
the
board
of
nursing
is
just
going
to
say
no,
no,
no
from
an
increase
in
education,
I
mean
what
else
can
we
do.
L
You
know
ways
that
perhaps
they
can
better
understand
the
difference
between
associate
degree,
nurses
and
bachelor
degree
nurses,
because
we
sometimes
feel
like
we're
held
to
some
standards
that
are
perhaps
should
perhaps
be
different
for
the
population
that
we're
bringing
our
nurses
still
pass
the
same
exam
and
they
must
pass
that
exam
to
to
go
ahead
and
move
into
the
workforce.
So
we
would
welcome
the
opportunity
to
work
with
the
kentucky
board
of
nursing
to
consider
caps.
L
We
certainly
see
the
need
to
have
the
appropriate
resources
to
teach
and
and
have
a
good
experience
for
our
students.
We
certainly
understand
that
we
have
another
another
group
keeping
watch
on
our
programs
through
our
national
accrediting
agencies
that
help
us
define
again
quality,
but
we
would
welcome
working
with
the
kentucky
board
of
nurses
to
look
at
how
to
more
quickly
increase
cap
numbers.
E
N
E
A
Okay,
thank
you
and
representative
bray.
Do
you
have
a
question.
G
Yes,
thank
you,
chairwoman.
Thank
you
all
for
your
robust
presentation.
I've
got
a
question
on
the
workforce
portion
of
it.
L
Yes,
sir,
we
are
able
to
provide
follow-up
information
on
our
various
students.
We
were
able
to
provide
a
little
bit
in
terms
of
our
graduates,
and
then
you
know
the
number
we
graduated
and
and
where
they're
going,
that
we
gave
you
today,
but
we
are
able
to
do
that.
A
lot
of
it
is
done
in
partnership
with
kentucky
stats,
and
so
they
tend
to
be
our
primary
provider
of
some
of
that
data.
We
follow
up
based
on
employment
out
three
years
after
our
student
leaves
us.
L
Our
enrollment
numbers
have
been
falling
over
the
past
three
years.
That's
a
national
trend
with
community
colleges.
We
do
know
that
our
university
partners
aren't
necessarily
seeing
the
same
thing,
so
some
of
it
may
be
well.
I
guess
it's
twofold.
I
showed
earlier
that
our
students
tend
to
be
older,
which
means
they
tend
to
work
or
have
child
care
issues,
and
we
feel
like
especially
over
the
last
two
years,
the
child
care
issues
and
the
uncertainty
about
virtual
school
versus
in-person
school,
I
think,
has
impacted
some
of
our
enrollments.
L
L
L
The
wages
are
pretty
high
because
there
are
shortages,
and
so
individuals
may
be
choosing
to
go
to
work
before
they
go
to
school,
and
then
we
hope
that
we
can
grab
them
as
they
get
to
work
and
start
them
down
a
path,
because
we
know
that
some
higher
education,
a
certificate
of
diploma
or
degree,
will
provide
them
more
stability
and
more
economic
success
across
their
work.
Life.
D
Thank
you,
madam
chair
and
first
I
want
to
commend
everyone.
Who's
made
a
testimony
today
and
also
that
you're
working
together
on
this
issue,
because
it
does
affect
all
of
us-
and
I
want
to
echo
corey's
sentiments
earlier,
regardless
of
what
comes
out
of
this
task
force
and
recommendations
whenever
we
adopt.
If
we
haven't
improved
the
quality
of
the
work
life,
we
really
haven't
accomplished
anything,
and
we
know
we
spend
double
what
other
industrialized
nations
does
on
the
administration
of
health
care.
D
So
I
would
encourage
you
folks
to
also
work
collaboratively
to
challenge
this,
to
really
look
at
each
and
every
regulation,
that's
affecting
health
care
and
see
if
it
really
brings
value
to
the
system.
I
think
there's
a
lot
that
doesn't
value
to
me.
Is
it
either
increases
the
quality
of
care
or
improves
efficiencies
or
both,
and
I
think
that's
one
thing's
lacking
electronical
medical
record.
In
theory,
it's
a
great
idea,
practical
application.
D
It's
not-
and
I
was
one
of
the
earliest
proponents
of
rural
hospitals
to
do
this,
and
I've
admitted
it's
a
mistake
because
it
wasn't
a
good
system
out
there.
It's
decreased
productivity,
25,
30
percent
and
truly,
I
don't
think
at
this
point-
has
improved
the
quality
care,
so
we
need
to
be
encouraged
enough
to
step
away
from
those
things,
but
we
really
need
to
be
aggressive
on
this
and
appreciate
the
report
that
dr
alvarado
referenced,
but
I'm
sure
since
2013,
a
lot
of
things
have
been
added
that
have
added
to
this
problem
as
well.
A
Thank
you
and-
and
I
absolutely
agree
with
all
the
points
that
you've
made,
and
I
think
that
we've
had
a
really
good
discussion
here
today.
So
I
appreciate
everyone
being
here.
I
I
think
you
know
on
on
one
last
note
before
we
leave
is
we
don't
just
have
a
health
care
worker
shortage?
We
also
have
an
increased
demand
and
we've
seen
that,
certainly
through
covid,
but
we
also
have
you
know
an
increased
demand
because
of
our
mental
health
needs
our
addiction
issue
and
our
our
poor
health
metrics,
our
chronic
disease
state.
A
So
I
think
that
you
know.
While
we
work
on
all
of
this-
and
this
is
absolutely
a
priority-
that
we
also,
we
don't
forget
that
we,
you
know
we
are
driving
the
demand
for
those
healthcare
workers
because
of
all
these
other
issues.
So
thank
you
so
much
for
being
here.
Thank
you
for
your
work
and
I
look
forward
to
working
with
all
of
you.
Thank
you
so
much.
Thank
you.
A
Next,
we
have
a
report,
an
update
on
the
public
health
transformation,
and
I
believe
that
commissioner
stack
has
been
very
patiently
waiting
to
give
us
an
update
and
we
also
have
jan
chamnis
with
the
department
of
public
health
as
well
so,
and
maybe
sarah
best
is
with
us
from
the
local
health
departments.
A
So
if
you
are
on,
if
you
could
just
introduce
yourselves
for
the
record
and
go
ahead
with
your
presentation,
thank
you
so
much
thanks
for
your
patience.
G
Thank
you,
representative
moser,
so
I'm
here
to
support
the
importance
of
public
health
transformation.
This
was
a
topic
that
is
desperately
needed
and
where
the
legislature
worked
very
collaboratively
last
year
and
leading
up
to
last
year
with
the
local
health
departments
across
parties
across
multiple
different
constituencies
to
bring
about
needed
reform.
Jan
chamnis
and
sarah
jo
best
will
introduce
themselves
as
they
do
their
presentation,
but
jan
is
the
director
of
public
health
transformation
at
the
kentucky
department
for
public
health.
G
In
addition
to
having
been
our
division
leader
for
women's
health
and,
of
course,
sarah
joe
best
is
the
lincoln
district
trail,
lincoln
trail
district
health
department,
director
and
also
the
president
of
the
kentucky
health
department's
association.
They
are
going
to
give
presentations
to
you
and
then
I'm
going
to
be
available
with
them
for
q.
A
so
thank
you
for
the
opportunity
to
be
here
and
jan
I'll
hand
it
to
you.
J
And
can
everyone
see
the
screen
just
a
thumbs
up
from
somebody?
Yes,
we
can
all
right
great
thanks.
Thank
you
again,
thank
you
for
this
opportunity
to
allow
me
to
come
and
talk
about
public
health
transformation
and
the
progress
since
the
passage
of
house
bill
129.
J
I
wanted
to
just
briefly
go
back
to
the
overall
purpose
of
public
health
transformation,
as
you
all
have
seen
before.
This
was
the
map
that
was
introduced
in
2018
and
it
represents
the
pension
crisis
across
the
state
where
the
employer
pension
contribution
rose
exponentially
and
forced
local
health
departments
to
either
react
through
layoffs
and
elimination
of
programs
or
risk
closing
their
doors.
J
Some
other
things
happen
prior
to
this.
The
pension
crisis,
which
also
impacted
local
health
departments
like
federal
and
state
policies,
the
affordable
care
act
and
kentucky's
medicaid
expansion,
good
policies,
but
diverted
programs
that
were
once
provided
in
local
health
departments
to
either
a
medical
home
or
a
primary
care
provider.
J
Another
reason
to
move
toward
transformation
is
this
national
model
which
you're
seeing
two
models?
One
on
the
left,
which
is
was
introduced
by
the
institute
of
medicine,
the
one
on
the
right
by
the
department
for
health
and
human
services
and
the
cdc,
but
both
models
really
were
a
call
to
action
to
public
health
across
the
country
to
address
social,
environmental
and
economic
conditions
that
impact
our
health,
but
really
the
main
reason
to
transform
kentucky's
public
health
system
is
because
what
we're
doing
now
is
just
not
working.
J
This
is
the
latest
report
from
the
county
health
rankings
or
america's
health
rankings
that
show
kentucky's
health
behaviors
as
48th
and
health
outcomes,
as
46.
so
simply
put.
What
we're
doing
is
just
not
working
we're
not
getting
any
healthier
as
a
state
or
as
individuals
and
public
health
transformation
is
really
our
call
to
action
to
work
together
to
create
this
more
efficient
and
stain.
A
sustainable
public
health
system
focused
on
improving
and
producing
better
health
outcomes
for
kentuckians
and
house
bill.
129
is
helping
us
do
just
that
house.
J
Bill
129
led
to
amendments
in
the
statutes
which
basically
allowed
introduced
this
categorization
of
public
health
programs
into
core
public
health,
which
included
foundational
public
health.
Those
programs
which
typically
are
legislatively
mandated
as
well
as
some
other
programs
in
public
health,
like
wic
and
hands,
and
those
programs
related
to
harm
reduction
and
substance,
use
disorder,
and
then
all
of
the
other
programs
were
put
in
this
category,
that
we
call
local
public
health
priorities
and
that
that
category
really
gave
local
health
departments
some
flexibility
and
some
option
to
choose.
J
Other
programs.
In
addition
to
assuring
that
core
public
health
services
were
met.
Additional
services
that
were
needed
as
a
result
of
their
specific
community
needs
another
amendment
to
the
statute
as
a
result
of
house
bill
129.
To
help
us
further
understand
the
local
public
health
priorities.
Was
this
introduction
of
these
key
terms
used
as
criteria
or
guidance
to
local
health
departments,
as
well
as
the
state
health
department
and
program
staff
to
to
better
understand
how
to
select
these
public
health
priorities
and
the
process
to
provide
these
public
health
priorities
in
their
communities?
J
And
we
are
still
working
at
with
public
health
transformation
efforts
to
further
define
these
key
terms
so
that,
as
a
as
a
state
department
for
public
health
and
local
health
departments,
we're
providing
some
consistency
across
the
state
and
rolling
this
out?
One
of
the
first
things
that
we
needed
to
do
was
really
it's.
It's
easy
to
say
that
anything
that
wasn't
core
was
pushed
into
local
public
health
priorities,
but
we
really
needed
to
specify
what
those
programs
were,
and
so
the
work
over
the
last
year
has
done
just
that.
J
It's
it's
just
that
these
are
programs
that
now,
once
local
health
departments
consistently
provide
those
core
public
health
programs,
then
they
can
pick
and
choose
and
and
choose
to
focus
more
on
the
selection
of
these
programs
based
on
their
local
needs
assessment
within
their
specific
communities.
J
J
129
we've
been
moving
on
a
fairly
good
pace
over
the
past
year
house,
bill
129
was
the
focus
during
2019
and
then,
in
october
of
last
year,
we
launched
relaunched
a
fairly
substantial
planning
effort
focused
on
public
health
transformation,
obtaining
buy-in
that
this
initiative
was
not
a
directive
at
the
local
health
departments,
but
rather
a
collaborative
effort
of
state
and
local
public
health
to
really
improve
public
health
and
redefine
public
health
and
moving
forward.
It
has
led
to
a
number
of
work
groups
and
work
plans.
J
It
has
led
to
the
iteration
of
a
new
strategic
plan
using
public
health
transformation
as
a
key
tool
in
overseeing
the
strategic
planning
efforts.
We
have
focused
on
health
equity
and
in
looking
through
this
lens
of
health
equity.
In
all
of
our
programs
and
we've
had
some
fairly
robust
leadership
and
staff
development
through
this
process
and
as
we
move
forward,
we
will
see
that
we
now
have
a
very
updated
strategic
plan,
along
with
this
public
health
transformation.
J
Creating
this
this
culture
of
change
to
to
move
forward
and
really
focus
on
changing
public
health
and
redefining
public
health.
J
This
is
not
intended
to
be
any
type
of
hierarchical
organizational
chart,
but
rather
just
a
way
that
we
manage
the
process
in
moving
forward
and
we'll
see
this
process
continue
as
we
as
we
roll
out
the
implementation
plan
into
the
future
beginning
with
this
month
and
going
into
next
year
so
and
in
the
next
several
years.
So
I
just
wanted
to
share
that
this.
This
is
a
very
complex
and
comprehensive
process
that
we've
been
through.
J
I
wanted
to
point
out
the
strategic
map,
and
I
know
that
it's
hard
to
see
on
the
slide-
and
I
believe
you
have
a
copy
of
it
in
your
packet,
but
you'll
note
that
the
street,
this
strategic
map
was
actually
adopted
in
2012,
and
so
it
really
hasn't
changed
a
whole
lot.
The
strategic
priorities
continue
to
be
people,
quality,
efficiency
and
effectiveness
and
building
public
health
capacity.
J
All
leading
to
our
focus
on
our
mission
to
improve
the
health
and
safety
of
people
in
kentucky
through
prevention,
promotion
and
protection.
We
did
tweak
it
a
little
bit
to
really
infuse
this
overarching
principle
of
promoting
health
equity
in
all.
We
do,
but
I
just
wanted
to
emphasize
that
our
strategic
planning
efforts
have
are
not
new.
We've
had
a
rich
history
of
strategic
planning
for
quite
some
time,
just
to
give
you
a
little
progress
to
date.
J
Through
this
process,
we
have
a
designated
public
health
transformation
team,
with
a
focus
on
performance
management
and
accountability,
and
we've
really
worked
on
enhancing
our
partnerships
with
some
of
our
external
partners,
like
the
kentucky
primary
care
association
and
some
of
their
fqhc
members,
as
well
as
university
and
hospital-based
primary
clinic
care
clinics,
and
I
think
that
we
really
are
start
starting
to
see
public
health
transformation
as
a
movement.
That's
going
throughout
public
health
in
kentucky
to
create
this
culture
of
change.
J
So
with
that,
I
will
turn
it
over
to
sarah
jo,
to
give
her
presentation.
O
O
As
jan
mentioned,
my
name
is
sarah
jo
best,
I'm
the
president
of
the
kentucky
health
departments,
association
and
the
public
health
director
here
at
lincoln
trail
district
health
department,
and
I'm
going
to
talk
to
you
a
little
bit
about
what
this
means
for
the
local
health
department
and
how
we've
been
impacted
from
it
and
some
successes.
Really.
I
will
focus
a
lot
on
the
successes
and
that
you
guys
have
performed-
and
I
want
to
thank
you
for
your
work
on
this.
O
So
as
the
president
of
the
kentucky
health
department's
association,
I
represent
60
of
61
local
health
departments
across
kentucky,
and
our
executive
director
is
dana
nichols.
As
jan
mentioned,
public
health
transformation
was
born
a
necessity,
many
local
health
departments
faced
financial
instability.
We
simply
couldn't
be
everything
for
everyone,
and
we
often
quoted
ourselves
as
being
a
mile
wide
and
an
inch
deep
transformation
really
provided
a
narrowing
of
that
focus.
O
O
This
is
the
stool
analogy
that
was
used
a
lot
during
that
time,
when
we
were
working
on
public
health
transformation
and
I'll
just
say
as
one
of
the
cada
members
a
long
time
ago,
when
we
were
sitting
around
a
table
at
a
caden
meeting
doing
a
strategic
plan.
We
really
wanted
this
to
happen.
We
saw
we
had
that
vision.
I
think
jan
was
around
that
table
too
at
that
time
as
a
local
health
department
director
and
just
to
be
where
we
are
today
and
the
successes
that
have
come
out
of
this.
O
The
collaboration
that's
come
out
of
this,
and
and
really
the
change
in
culture
is
something
that
I'm
incredibly
proud
to
have
been
at
the
very
beginning
of,
and
now
as
we
move
toward
implementation,
the
stool
analogy.
O
The
three
legs
of
the
stool
were
focused
services,
so
introducing
that
simplified
and
focused
public
health
model
with
clearly
defined
priorities
that
prevented
duplication
of
effort,
reduced
waste
internally
and
externally,
and
also
provided
the
ability
to
have
more
collective
impact.
So
before
in
kentucky,
if
you
saw
one
health
department,
you
saw
one
health
department.
Now,
if
you
see
the
health
department,
you'll
see,
similarities,
you'll
see
a
core
package
of
service
and
there's
more
consistency,
thus
making
us
more
accountable
to
the
public
that
we
serve
and
our
services
more
recognizable.
O
The
pension
system
stabilizing.
That
was
also
a
big
key
for
us
on
our
leg
of
the
stool.
This
allowed
for
more
manageable
planning
and
budgeting
for
local
health
departments.
It
provided
the
opportunity
to
add
staff
at
normalized
cost
and
then
the
last
leg
of
that
was
equitable
funding
and
that
really
created
an
equitable
funding
formula
for
foundational
or
statutorily
required
services
to
ensure
that
all
kentuckians
have
access
to
these,
regardless
of
their
zip
code.
O
You've
seen
the
image
of
the
core
public
health
package
jan
showed
you
that
you'll
see
it
throughout
the
course
of
many
of
the
presentations
that
we
do
on
public
health
transformation,
but
this
was
so
important
to
us
as
local
health
departments,
that
the
work
that
went
into
this
really
simplified
focus
and
prioritized
public
health
services,
and
it
did
so
by
assuring
that
these
statutorily
required
services.
That's
where
we
put
our
resources
first,
it
really
prioritized
them
to
be
first,
and
I
can
say,
as
a
local
health
department
director
that
wasn't
always
the
case.
O
We
may
put
a
lot
of
resources
over
here
and
we
may
neglect
or
use
leftover
if
you,
if
you
will
funding
or
resources
to
fund
areas
on
on
the
left
and
those
are.
O
These
are
really
the
things
that
have
been
studied
and
tried
and
true
that
if
we
put
resources
here
and
we
devote
time
and
energy
to
them,
we
do
see
changes
in
health
outcomes
in
our
community,
and
so
that
was
really
important
to
us
that
not
only
were
they
required
by
statute,
but
our
statutes
actually
matched
what
a
healthy
public
health
system
would
look
like.
O
So
it
ensures
that
resources
go
here
first
and
then
it
also
established
the
core
public
health
services,
such
as
wic
hands
and
harm
reduction,
as
as
jan
mentioned,
and
that's
really
because
those
were
needed.
We
understood
that
while
they
may
not
be
statutorily
required,
our
community
health
assessments
across
kentucky
were
consistent
enough
that
these
three
areas
were
needed
all
across
kentucky.
O
The
new
thing
with
this,
too,
is
the
the
addition
of
a
community
health
assessment.
Here
that
was
long
overdue
and
as
a
result
of
public
health
transformation
is
now
included
in
902
kar
8160,
and
that
is
a
really
good
thing.
It
provides
accountability
for
programs
that
we
may
do
jan
mentioned.
An
assessment
is
something
that
we
would
have
to
do.
If
we
want
to
do
other
optional
programs,
it
uses
data
to
drive
decisions
and
that's
really
important,
so
it
uses
qualitative
and
quantitative
data.
O
It
uses
community
input
to
help
drive
where
we're
putting
resources
and
requires
us
to
evaluate
to
make
sure
that
we're
having
the
intended
outcomes
that
we
want
so
using
data
to
drive
decisions
is
now
also
outlined
in
krs-21187.
That's
also
a
positive
impact
from
public
health
transformation.
O
This
slide
really
looks
at
stabilization
of
the
pension
system.
As
you
know,
every
fall
krs.
We
crunch
the
numbers
determine
how
large
the
unfunded
liability
was
recommend
a
percentage
of
payroll
to
employers
to
keep
the
pension
system
viable
for
another
year.
Many
public
health
employers
responded
by
decreasing
their
payroll,
thus
controlling
their
pension
costs,
many
outsource
to
private
contractors
who
didn't
provide,
who
don't
provide
state
pensions
and
don't
pay
into
krs.
There
was
an
over
51
percent
decrease
in
staff
and
local
health
departments
from
2008
to
220
2020.
O
In
order
to
help
control
these
costs
house
bill,
8
froze
the
pension
contribution
rate
in
statute
and
enabled
local
health
departments
to
better
forecast
operational
costs
and
pension
contributions
for
decades
to
come.
So
this
also
eliminated
the
constant
uncertainty
of
the
ever-changing
arcs.
It
stayed
in
thus
stabilizing
the
quasi-pension
issue.
It
also
provided
the
opportunity
to
bring
new
employees
on
at
normalized
cost,
which
was
advantageous
for
us
as
well.
O
So,
while
house
bill
8
did
provide
for
better
budgeting
and
was
financially
beneficial
for
33
out
of
61
local
health
departments.
There
was
27
local
health
departments
that
saw
their
rates
increase
to
85
or
above,
and
these
ranged
anywhere
from
roughly
85
to
300
percent.
So
it
should
be
noted
that
there
are
health
departments
that
will
not
be
able
to
support
the
increase
after
the
loss
of
half
of
the
subsidy,
even
through
taxation.
O
Currently,
we
have
48
counties
above
the
state
average
of
4.72
cents
per
100
of
assessed
property
value,
seven
that
do
not
have
established
public
health,
taxing
districts,
nine,
who
have
tax
rates
at
eight
percent
or
higher,
leaving
very
little
room
for
growth
and
two
who
are
already
at
the
maximum
tax
rate,
which
is
10
cents
according
to
krs.
212
725,
also
keep
in
mind
that
the
counties
at
the
highest
tax
rates
are
typically
poorer.
O
Another
success
here
in
the
equitable
funding
was
the
evaluation
of
fees
associated
with
our
environmental
permits.
This
was
also
work
done
under
public
health
transformation
amendments
for
may
to
care,
as
211
180,
to
allow
for
improved
alignment
of
fees
with
actual
cost
of
providing
those
services
which
will
reduce
the
amount
of
public
health
tax
dollars
used
to
support
private
business
permits.
O
Public
health
transformation,
as
I
mentioned
before,
did
identify
an
equitable
funding
formula
and
that's
the
work
that
that
cada
has
put
on
on
the
priority
for
this
year
is
really
assuring
that
equitable
funding
formula
occurs.
So
it
basically
looks
at
the
cost
of
providing
foundational
services,
which
are
those
services
that
are
required
by
statute.
It
wasn't
intended
to
include
the
cost
for
any
of
the
other
programs
to
include
core
community
identified
services.
Most
of
our
core
services
are
funded
by
specific
grants.
O
The
calculation
is
based
on
the
absolute
minimum
number
of
employees
needed
to
conduct
those
statutorily
required
services
based
on
the
population
size
of
the
service
area,
and
it's
directly
linked
to
things
like
the
cost
of
salary
benefits
and
operations.
It
also
depends
on
the
evaluation
of
the
actual
retirement
costs
for
foundational
employees.
After
that,
cost
is
determined.
It
requires
the
minimum
public
health
tax
be
dedicated
to
those
foundational
services.
O
O
We
are
working
on
this
to
get
numbers
for
fiscal
year
23..
Our
estimations
at
this
point
are
7.7
to
9
million
dollars,
but
we
will
have
those
very
shortly
and
are
working
on
them
right
now.
I
also
wanted
to
demonstrate
with
this
slide,
the
commitment
from
the
local
level
and
ensuring
those
foundational
services
are
provided.
A
Thank
you
so
much
sarah,
joe
and
jan
for
those
great
presentations.
You
are
reminding
me
of
what
a
big
project.
This
was
what
a
great
collaborative
effort
this
was,
and
I'm
so
proud
of
all
the
work
that
we
were
all
able
to
do.
I
know
that
you
know
there
was
a
lot
of
work
that
took
place
behind
the
scenes
for
years
leading
up
to
this
legislation,
so
I
I
think
this
is
a
great
thing.
A
It's
very
data,
driven,
as
you
said,
and
very
common
sense
and
and
a
great
example
of
of
dph
transformation,
really
finding
it
finding
efficiencies
that
you
know.
Perhaps
we
can
take
this
this
model
into
other
areas
of
state
government.
I
I'm
very
proud
of
this
so
and
you're
right.
We
need
to
fund
this.
We
need
to
make
sure
that
this
that
we
complete
this
this
whole
project
with
with
the
funding
this
year.
So
thank
you.
Do
we
have
any
questions
from
the
committee?
A
O
O
O
A
A
All
members
receive
those
ahead
of
time.
So
hopefully
there
aren't
any
questions
and-
and
those
are
just
for
review-
do
you
have
something
represented
fleming.
C
Yeah,
I
didn't
know,
if
so
nobody's
here,
to
just
discuss
or
review
the
block
grants
in
general.
A
A
C
I
do
I
won't
be
very
long.
I
want
to
ask
laura
just
a
couple
of
questions
about
community-based
services
and
such
do.
You
know
how
many
past
due
cases
do
we
have
statewide
not
regards
to
the
you
know
for
child
protective
services.
G
C
I
I
would
appreciate
it:
I've
been
getting
reports
and
understand
that
the
a
lot
of
these
case
loads
on
these
workers
are
anywhere
from
80
to
100
in
excess
of
that.
And
when
you
look
at
number
of
past
dues,
it
seems
quite
quite
alarming
that
these
are
not
being
handled
or
worked
through,
and
I
just
did
some
quick
numbers.
It
looks
to
me.
C
Well,
I
know
from
the
statutes
it's
be
should
be
25
or
less
in
terms
of
workload
and
when
you
look
at
just
the
average
number
of
past
due
cases
at
least
I
believe
this
in
louisville
and
jefferson
county
it's
around
34.
That
in
itself
is
above
25,
but
when
you
add
on
additional
of
cases
that
are
in
the
process,
you
know
that's
around
25
additional
cases.
So
I
want
to
bring
that
up
to
your
attention.
G
Yes,
sir,
yes
caseload
size
definitely
has
been
an
issue
for
the
past
few
years
in
jefferson
county.
Those
numbers
were
around
80
case
loads
per
social
worker.
A
couple
years
ago,
we
have
worked
hard
to
get
those
numbers
down.
I
believe
the
35
number
that
you
reference
is
the
total
cases,
including
past
due,
but
also
including
cases
currently
being
worked.
G
G
There
are
some
issues
specific
to
jefferson.
You
know
the
case.
Load
number
is
different
throughout
regions
throughout
the
state.
But
again
I
would
be
more
than
happy
to
provide
you
that
information.
We
are
statutorily
required
to
report
on
that
quarterly
and
case
loads
right
with
recruitment
and
retention,
they're
all
being
focused
on
by
dcbs
right
now,
as
we
work
to
build
a
21st
century
dcbs
and
and
really
focus
on
again
recruiting
retaining
social
workers,
that's
the
the
best
way
to
get
that
caseload
size
down.
C
Appreciate
I
just
want
to
make
sure
that
when
you
said
35
I
mean
I've
got
the
average
almost
60.
When
you
look
at
one
particular
area,
it's
almost
60
cases
which
is
broken
down
between
34
past
two
and
25
that
are
currently
active.
So
I
need
to
get
some
clarification.
C
I
want
to
labor
this
a
little
more,
but
if,
if
it's
up
to
the
chairs,
I
would
like
to
have
you
all
come
in
and
like
once
again
it's
up
to
the
chairs
to
have
you
all
come
in
and
give
a
little
more
full
report
on.
What's
going
on
in
addition
to
that,
your
plan
of
action
since
you've
mentioned
that
this
has
been
going
on
for
several
years.
C
I
guess-
escalated
during
the
pandemic
and
I'm
afraid
that
the
spike
is
going
to
really
increase
and
we're
going
to
cause
some
look
at
some
individuals
who
might
get
opportunity
to
go
elsewhere
to
get
a
higher
paid
that
you're
going
to
get
in
a
worse
situation.
C
A
And
thank
you
laura
for
indulging
us.
Yes,
this
is
an
ongoing
question.
We've
had
some
updates
from
dcbs
and
commissioner
straub
in
in
the
recent
months,
but
I
would
like
to
dig
down
on
this
a
little
bit
further.
So
thank
you
for
bringing
that
to
our
our
attention
again.
Now
we
need
to
consider
some
regs
and
these
have
all
been
reviewed.
A
There
is
one
regulation
that
we
would
like
to.
I
think
there's
been
a
recommendation
to
defer
to
move
201
k,
a
r
009
290
proposed
legislator
proposed
regulation
having
to
do
with
athletic
trainers,
and
I
know
that
the
kbml
they
are
under
kbml,
so
they've
written
these
regs
and
there
have
been
some
public
comments
and
we
believe
that
there
is
a
need
to
defer
this
reg
for
further
action,
and
I
will
entertain
a
motion
to
do
so.
So.