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A
A
C
E
A
Am
here
in
the
room?
Okay,
thank
you.
Madam
secretary,
we
have
a
quorum
established
to
do
business
and
I
again
appreciate
everyone
being
here.
We
will
have
some
members
who
are
in
and
out
to
attend
other
meetings,
other
committees
and
are
there
any
members
who
would
like
to
introduce
guests
representative
raymond.
F
Yes,
thank
you.
I
want
to
introduce
some
wonderful
young
women
from
mercy
academy
in
louisville.
You'll,
see
them
throughout
the
capitol
today
welcome
mercy,
girls,
and
I
want
to
introduce
my
friend,
shumika
parrish
wright,
a
leader
in
louisville
and
a
candidate
for
mayor
of
louisville.
Thank
you
all
for
being
here.
A
Okay,
all
right,
thank
you
very
much.
I
just
once
again
want
to
welcome
everyone.
I
have
a
lot
of
good
friends
here
today,
dr
graducki.
It's
really
a
pleasant
surprise
to
see
you
today.
So
thank
you
for
being
here
and
I
think
we
will
go
ahead
and
I
don't
know
if
we
have
any
announcements.
I
you
know
just
silence
your
phones
and
you
know
the
drill
I
mean
just
be
respectful
of
the
the
space.
I
guess
that
we
have
here.
A
If
you
again,
if
you
want
to
socially
distance,
we
have
130
room
131
to
do
that.
The
first
bill
that
we
will
consider
is
senate
bill.
11.,
senate
senator
and
chair
ralph
alvarado
is
here
to
discuss
this
legislation
with
us
today.
Please
invite
your
guests
to
the
table.
Everyone
please
introduce
yourselves
for
the
record
and
proceed.
G
G
G
They've
provided
a
lot
of
input
groups
like
the
alzheimer's
association,
the
ombudsman's
office,
even
the
kentucky
justice
association,
lots
of
groups
this
bill
effectively,
just
modernizes
kentucky's,
assisted
living
social
model
to
align
more
closely
with
the
vast
majority
of
states
in
the
union.
It
allows
assisted
living
communities
to
deliver
basic
health
care
services
in
an
environment
that
encourages
meaningful
aging
in
place.
G
It's
got
endorsements
of
again
a
lot
of
the
folks
that
are
here
at
the
table
and
I'll.
Let
them
kind
of
address
the
committee
here
in
a
moment,
but
it
basically
updates
assisted
living,
not
its
payer
source
assistance.
Living
is
going
to
remain
a
consumer-driven
private
pay
model
where
the
resident
signs
a
lease
for
an
apartment
subject
to
a
landlord
type
of
tenant
law
emerges,
personal
care,
which
is
a
basic
health
services
model
with
assisted
living,
which
is
currently
a
social
model
into
one
broader
licensure
category
called
assisted
living
communities.
G
G
So,
in
order
to
remove
a
lot
of
that
confusion,
it
merges
private
pay,
apartment
style,
personal
care
homes
with
private
pay,
apartment
style,
assisted
living
care
facilities
also
expands
the
definition
of
assisted
living,
which
will
include
care
from
just
beyond
independent
living
until
skilled
nursing
or
a
secured
dementia
care
unit
is
required
without
regard
to
physical
location
of
the
resident's
apartment.
Also,
we
have
the
provider
there's
a
lot
of
concern
about
some
of
the
providers
that
they're
able
to
choose
how
much
care
to
offer
within
the
broader
definition
of
assisted
living.
G
So
should
a
provider
choose
to
only
serve
low
acuity
social
model
residents
who
don't
reside
in
a
secure
dementia
unit?
Staffing
will
be
different
in
quantity
and
qualification
than
if
the
provider
delivers
basic
health
care
services
and
providers.
Will
staff
train
and
implement
policies
and
procedures
appropriate
to
the
care
being
provided
and
the
nurse
practice
act
will
control
when
credentialed
staff
will
be
required
as
well
I'll
just
mention
we
had
a
task
force.
G
I
know
a
couple
of
years
ago
here,
the
cap,
you
know
we
also
had
the
cabinet
involved
and
this
kind
of
aligns,
with
the
recommendations
of
the
general
assembly's
alzheimer's
and
dementia
workforce
assessment
task
force.
In
order
to
get
this
done.
The
current
prohibition
on
delivery
of
health
services
was
listed
as
a
significant
problem
in
the
2019
task
force
report.
So
this
helps
address
a
lot
of
those
issues,
you're
going
to
hear,
probably
from
the
alzheimer's
association.
G
In
a
moment
I
know
the
alzheimer's
association
was
involved
in
the
initial
filing
of
this
bill
and
getting
this
bill
formulated,
it's
based
off
of
and
strongly
influenced
by
minnesota's
assisted
living
statute.
After
that
initial
bill
was
done,
they
had
20
requests
for
edits
to
the
bill.
18
of
those
were
done.
One
of
them
is
achieved
by
regulation
and
there's
one
last
one
that
they
don't
like,
and
so
they'll
probably
be
here
to
oppose
the
bill
because
they
didn't
get
the
one
out
of
the
20
that
they
wanted
to
get.
G
They
got
everything
else
put
into
the
bill.
We
also
have
again.
I
mentioned
the
kja
had
some
requested
language
that
was
put
in
cabinet
had
a
few
quite
a
few
requested
changes
into
the
bill.
Those
were
put
in
we've
also
had
the
ombudsman
office,
which
requested
to
be
to
have
some
oversight
over
a
lot
of
these
facilities,
and
so
they've
been
included
as
well.
It's
been
a
a
labor
of
love,
but
we've
gotten
this
bill
to
this
point.
G
H
H
Right
now
we
have
a
pure
social
model
and
are
sort
of
the
the
the
last
state
to
have
that
and
currently
assisted
living
providers
are
not
able
to
deliver
even
the
most
basic
of
health
service,
such
as
clipping
toenails,
communicating
directly
with
the
doctor's
office
to
convey
a
concern,
communicating
anything
more
than
the
bare
facts
to
family
members.
This
fixes
that
and
over
the
over
the
years,
people
coming
into
assisted
living
have
be
largely
because
of
better
choices
to
support
them,
while
they
remain
in
their
homes.
H
H
A
F
Real
quickly,
I
think
this
is
a
great
bill.
The
only
concern
I
have
in
speaking
with
some
constituents
is
that
the
social
model
I
know
gets
grandfathered
in,
but
rather
than
have
the
social
model
under
the
oig
rather
than
dale,
is
there
a
possible
way
to
leave
it
as
it
is
as
compared
to
bring
it
under
the
office
of
the
oig.
H
Representative
dotson,
thank
you
for
that
good
question.
This
isn't
the
first
time
that
I've
heard
it
and
ultimately
senate
bill.
11
does
not
address
anything
other
than
that's
the
choice
of
the
cabinet,
our
assumption
from
conversations
with
everyone
from
secretary
friedlander
to
the
inspector,
general,
etc.
H
H
H
We
had
baked
a
lot
of
those
into
the
to
the
bill
that
was
pre-filed
by
senator
alvarado,
the
senate
committee
sub,
put
more
in
as
we
continued
to
talk
with
them
after
the
toward
the
end
of
the
interim,
and
there
were
only
three
issues
that
I
can
recall
that
they
said
we'd
like
this.
At
the
end
of
the
day,
we
we
just
said
we
can't
quite
get
there
and
inspector
general
indicated
to
me
that,
to
the
best
of
his
knowledge,
they
would
not
be
here
to
testify.
F
L
G
That
that'll
be
completely
up
to
the
to
the
providers.
So
if
the
providers
want
to
provide
some
of
those
basic
services
they
can,
if
they
want
to
stay
in
a
social
model
and
not
offer
them
they
can,
they
can
stay
in
the
same
model
that
they
offer
now
if
they
offer
some
and
we're
seeing
more
of
them,
starting
to
do
that.
G
So,
if
you're
in
a
some
of
these
facilities,
they'll
have
a
nurse
that
might
be
on
duty
that
might
help
with
medications
or
like
something
as
simple
as
again
clipping
nails
or
doing
some
basic
drawing
labs
for
somebody
to
let
them
stay
where
they're
living
currently
they'll
be
now
under
oig
or
office.
The
inspector
general
for
review,
but
if
you
want
to
stay
in
a
completely
social
model,
you're
perfectly
allowed
to
do
that.
J
J
For
me,
my
beautiful,
brilliant
father,
who
was
in
full-time
medical
practice
at
the
time,
was
struck
with
early
onset,
dementia
had
louis
body
disease
16
years
for
the
first
12,
my
mother,
with
help
from
family
was
we
were
able
to
care
for
him
in
the
home.
It
was
tragic
because
he
was
so
bright
understood
what
was
happening
to
him
until
he
didn't
and
when
he
eventually
his
care
became
too
much
for
my
mother
and
for
us
to
handle.
J
We
went
to
a
number
of
different
care
facilities
where
they
were
told.
We
have
a
memory
unit,
we
have
expertise
and
alzheimer's
and
again
and
again
and
again
that
turned
out
not
to
be
the
case.
One
facility,
I
remember
getting
a
call
in
the
middle
of
the
night.
You
need
to
come,
get
your
father
right
now
he's
wandering!
J
Well,
that's
what
patients
with
dementia
do
when
they're
in
the
late
stages?
So
all
of
that
and
as
you
guys
know,
I
don't
generally
engage
in
a
lot
of
personal
stories
on
the
floor
and
committee,
but
we
had
numerous
experiences
in
nursing
homes
that
offered
specifically
dementia
care
memory
care
specialty
and
they
were
not
equipped.
J
It
was
very
disruptive
to
our
family.
It
was
very
disruptive
to
him
and
I
know-
and
I'm
telling
this
story
because
I
know
this
applies
to
so
many
other
kentuckians
that
we're
trying
to
help,
and
so
I
guess
my
concern
is
if,
if
the
agencies
that
are
already
in
business-
and
we
let
them
step
up
to
this-
as
I
understand
it,
step
up
to
this
new
level
of
licensure,
that
says
we
have
the
expertise
to
deal
with
this,
but
they're
not
required
to
have
any
additional
training.
J
They're,
you
know
not
given
any
they're.
Just
grandfathered
in
my
concern
is
that
families
will
continue
to
have
the
kind
of
really
terrible
experience
that
that
my
family
did.
And
so
what
can
you
do
to
assure
me,
assure
other
families
who
may
be
faced
with
this,
that
that
these
these
organizations,
who
do
say
they
provide
dementia
care,
they
do
provide
memory
care,
are
actually
going
to
develop
new
skills
in
order
to
to
do
it
properly.
G
And
thank
you
for
that
question
I
mean
obvious.
This
is
the
this
is
what
I
practiced
in
any
more
full-time.
We
know
that
the
more
disruption
there
is
for
patients,
the
higher
their
likelihood
of
having
breakthrough
behaviors
with
dementia,
the
more
you
can
keep
somebody
in
their
environment
the
better
off
they
are.
So
I
know
during
covid,
as
kobe
broke
out
in
a
lot
of
facilities,
a
person
with
dementia
got
moved
from
one
room
to
another,
to
create
an
isolation
area
for
patients
with
covid.
G
G
H
Thanks
senator
just
to
piggyback
on
what
senator
alvarado
said,
the
operating
requirements,
the
operating
statutory
mandates
and
regulations
after
they
transition
on
the
license
are
identical,
whether
you
are
a
new
provider,
a
new
applicant
or
an
existing
building
that
may
have
been
operating
a
with
the
full
blessing
of
the
cabinet
may
have
been
operating
for
five
ten
fifteen
years.
One
of
these
secured
dementia
care
units.
H
They
will
have
to
comply
with
the
same
regulations
and
be
inspected
on
the
same
basis.
The
only
difference
when
we
talk
about
grandfathering,
I
want
to
be
really
clear.
The
only
difference
is
a
recognition
that,
if
someone
holds
that
license,
or
in
the
case
of
assisted
living
certification,
that
authority
granted
by
the
state
of
kentucky
to
operate
one
of
these,
that
means
they
met
the
criteria
for
obtaining
that
okay
and
they
have
continued
to
meet
the
criteria
through
the
regular
ongoing
inspections.
H
H
I
I
sorry
thought
I
was
wrapped
up
on
training
this
significantly,
and
this
is
in
those
regs
going
forward.
Post
licensure
significantly
increases
training
required
for
people
who
work
on
that
unit
and
it
really
really
addresses
and
increases
those
who
are
in
charge
of
that
unit,
but
even
the
rank
and
file
people.
A
Okay,
thank
you
so
much
for
that
explanation,
because
I
I
have
received
some
questions
too,
about
the
grandfathering
in
of
of
the
existing
assisted
living.
So
I
very
much
appreciate
that.
I
think
it
was
very
thorough
and
I
know
how
hard
all
of
the
stakeholders
have
worked
on
this
bill.
I
really
appreciate
all
of
the
work.
I've
had
a
lot
of
conversations
about
this.
I
really
appreciate
the
work
that
you've
done
with
the
alzheimer's
association
as
well.
A
C
C
G
A
M
M
For
the
record,
so
sorry,
thank
you.
My
name
is
mackenzie
longoria,
director
of
public
policy
for
the
alzheimer's
association.
It's
our
advocacy
day
today.
So
thank
you,
many
of
you
stopped
by
today
and
are
wearing
purple.
So
we
really
appreciate.
I
just
want
to
give
a
quick
thank
you
for
those
of
you
who
did
that
chairwoman,
mosher
and
members
of
the
committee.
Thank
you
for
allowing
me
to
speak
today
regarding
this
piece
of
legislation.
M
It
is
my
job
to
speak
on
behalf
of
255
000
kentuckians
that
are
impacted
by
dementia
and
their
caregivers
throughout
the
commonwealth.
I
really
want
to
state
at
the
outset
of
my
testimony
that
the
concerns
held
by
the
association
are
have
been
and
remain
with
members
that
represent
the
industry
behind
this
piece
of
legislation.
M
Since
this
major
restructuring
to
the
assisted
living
in
kentucky
was
first
discussed
and
proposed,
the
association
has
worked
in
good
faith
to
seek
changes
for
three
critical
areas.
Very
respectfully.
There
were
not
a
list
of
20
demands.
There
has
been
a
concern
over
three
primary
areas
since
the
beginning
of
the
development
in
the
legislation
in
early
2020.
The
association
has
clearly
communicated
the
importance
of
addressing
these
three
areas
and
I'm
very
happy
to
say
that
one
of
those
areas
was
addressed
early
on
through
great
conversations
with
the
entities
involved,
and
one
issue
remains
outstanding.
M
However,
that
issue
is
an
area
of
grave
concern
for
the
association.
The
issue
still
outstanding
is
in
relation
to
existing
facilities
being
grandfathered
into
this
new
licensure
category.
What
we
just
heard
about,
unfortunately,
the
industry
has
not
worked
with
us
in
several
months
and
they
have
not
communicated
with
me,
despite
a
desire
to
find
a
comparable
solution
to
this
issue.
M
Section
14
of
the
bill
lays
out
the
requirements
for
providers
applying
for
the
assisted
living
community
with
dementia
care
license,
and
I
want
to
read
directly
here,
because
the
language
is
very
important
quote.
The
cabinet
shall
consider
the
following
criteria
for
licensure,
including
but
not
limited
to
the
education
and
experience
of
the
applicant
or
its
principles
in
managing
residents
with
dementia
or
other
dementia
illnesses
and
disorders
and
b.
The
compliance
history
end
quote.
M
M
I
want
to
take
a
moment
and
address
some
of
the
arguments
that
have
been
presented
in
support
of
this
clause
remaining
in
the
bill.
It
has
been
stated
that
we
don't
want
to
take
away
anything
that
these
facilities
are
already
in
possession
of
I'm
an
attorney
by
background,
and
I
absolutely
understand
this
notion.
However,
as
receptive
as
we
are
to
that,
we
are
not
taking
away
anything
that
these
facilities
already
possess,
as
the
license
does
not
yet
exist
further.
M
M
It
has
been
also
been
stated
that
many
of
these
facilities
have
been
providing
dementia
care
for
years
and
should
be
able
to
continue
to
do
so.
The
association
couldn't
agree
more.
We
want
people
who
provide
care
to
this
complex
population
to
continue
to
do
so,
but
we
want
to
help
them
in
being
able
to
provide
that
care
by
requiring
adherence
to
basic
standards.
M
These
facilities
have
had
no
guiding
statutes
or
regs
on
what
the
provision
of
dementia
care
or
memory
care
entails,
and
so
it
has
been
a
piecemeal
facility
by
facility
approach
further
in
nearly
every
other
licensed
or
professional
occupation
or
setting
from
nail
technicians
to
physicians.
We
still
require
people
to
recertify,
renew
and
re-educate
themselves
on
topics
that
they
deal
with
every
single
day.
Asking
asking
existing
facilities
to
do
the
same
is
what
we
expect
of
these
other
professional
settings.
M
Finally,
it
has
been
said
that
this
is
a
minor
concern
and
will
have
minimal
impact.
I
would
perhaps
agree
if
we
were
only
talking
about
a
handful
of
facilities,
but
this
grandfather
provision
would
mean
more
than
50,
assisted
living
facilities
and
almost
90
personal
care
homes
would
be
moved
into
this
new
category.
That's
almost
150
out
of
304
active
facilities
and
with
more
again
that
could
open
their
doors
between
now
and
july.
As
we
know,
many
of
these
facilities
halted
opening
during
the
pandemic.
M
That
is
why
it
is
crucial
for
all
facilities
to
be
subject
for
the
same
requirements
for
this
category.
If
we're
doing
an
overhaul
of
a
system,
let's
level
the
playing
field,
it
remains
our
goal
and
our
desire
to
support
this
bill
once
this
important
issue
has
been
addressed,
but
until
that
change
is
made,
we
have
to
respectfully
oppose
the
bill
senate
bill.
11
has
many
provisions
that
will
improve
our
current
assisted
living
structure.
M
N
M
A
O
You
so
much
chairman
and
members
of
the
house,
health
and
family
service
committee.
Thank
you
for
allowing
me
to
speak
today.
My
name
is
sherry
kolp
and
I'm
the
state
long-term
care,
ombudsman,
and
I'm
here
today
as
an
advocate
for
residents
and
consumers
of
long-term
care
facilities
with
concerns
about
senate
bill
11.
O
long-term
care
ombudsmen
are
authorized
and
defined
by
the
older
americans
act.
As
advocates
for
folks
who
live
in
long-term
care
facilities,
we
regularly
visit
the
residence
in
kentucky's
current
licensed
long-term
care
facilities,
and
we
help
them
solve
problems
with
their
care
and
services.
We
work
to
prevent
abuse
and
neglect
and
we
help
residents
exercise
their
rights.
Our
mission
is
to
improve
the
quality
of
care
senate
bill.
11
calls
for
making
assisted
living
a
new
level
of
licensed
long-term
care.
O
The
bill
also
allows
existing
personal
care
homes
to
convert
to
licensed,
assisted
living,
while
kentucky
does
need
to
modernize
assisted
living.
This
bill
does
not
do
enough
to
protect
residents
from
poor
care
abuse
and
harm,
as
written
assisted
living
facilities
would
be
inspected
about
every
two
years.
The
ombudsman
program
recommends
that
assisted
living
facilities
be
inspected.
On
the
same
type
of
annual
schedule
that
other
long-term
care
facilities
are
inspected
on,
in
addition,
the
bill
exempts
assisted
living
facilities
from
type
a
and
type
b
citations
which
are
used
when
residents
experience,
abuse,
harm
and
neglect.
O
This
also
limits
citations
to
no
more
than
five
hundred
dollars.
The
long-term
care
ombudsman
program
recommends
assisted
living
facilities,
not
be
exempt
from
type
a
and
type
b
citations
and
their
penalties
not
be
capped.
At
500.
Kentucky
must
be
able
to
hold
all
long-term
care
facilities
accountable
for
harm
and
abuse.
O
We're
also
concerned
about
the
issue
that
miss
longoria
from
the
alzheimer's
association
mentioned,
and
I
won't
belabor
that
but
grandfathering
some
facilities
into
this
new
licensure
level
of
care
would
have
them
be
exempt
from
certain
initial
requirements.
Every
facility
converting
to
this
new
licensure
needs
to
meet
the
same
requirements.
It
needs
to
be
confirmed.
They
they
have
the
knowledge
and
the
skills
to
provide
dementia
health
care,
since
they
are
moving
from
a
social
model
to
licensed
health
care
facility.
A
N
Have
another
question
max
random
sec?
Madam
secretary,
madam
chair,
so
my
question
I
guess,
is
to
senator
alvarado
and
that
group,
why
have
they
exempted
or
the
inspections
just
every
two
years,
and
could
there
be
a
compromise
and
and
grandfather
the
folks
in
and
let
them
keep
their
licenses?
That's
as
they
work
on
their
licensure
requirements,
because
I
think
all
of
us
are
really
worried
about
our
vulnerable
elderly
people,
our
vulnerable
folks
with
dementia
and
we're
all
going
to
be
there
one
day.
N
G
I
think,
as
far
as
the
12
to
24
months,
I
think
if
they
fail
an
inspection,
they're
required
to
do
them
more
often
and
if
they,
if
they're
good
partners
and
they've
done
well
with
their
inspection,
then
we
got
them
out
to
24
months.
I
think
there's
some
national
statistics.
You
might
be
able
to
quote
on
that,
but
that's
how
we
achieve
that,
so
that
if
someone
does
a
good
job,
they
can
go
out
24
months
if
they
fail
they're
going
to
have
a
review
done
much
sooner.
H
Certainly,
nationwide
the
average
for
assisted
living,
re-licensure
inspections,
the
regular
inspections
is
19
months.
There's
a
handful
of
states
that
one,
the
one
that's
farthest
out.
There
is
60
months
as
a
provider.
It
made
no
sense
to
me
I
want
I
want
my
buildings
and
and
and
frankly
my
competition
to
to
be
assessed
more
frequently,
even
the
best
providers.
H
H
24
months,
keep
in
mind
representative
marzian
that
the
the
cabinet
has
now
and
will
continue
to
have
under
this
bill,
the
authority
to
come
in
at
any
point
in
time
that
there
is
a
credible
complaint
and
also
when
there's
been
a
significant
citation,
a
significant
deficiency.
Excuse
me,
the
the
state
can
come
back
in
and
verify
that
the
corrections
the
facility
says
it
has
made
were
timely
made
and
if
they
have
question
they
can
come
back
again
and
make
sure
that
they're
not
being
fed
incorrect
information.
N
G
G
So
the
alternatives
we
have
is,
I
think,
the
bill
that
is
before
us
and
the
way
it's
been
drafted
with
all
of
the
input
that's
been
received,
or
we
just
say
we'll
just
keep
going
the
way
we
are
with
the
confusion,
that's
out
there
and
the
concerns
that
are
out
there.
We've
made
a
lot
of
accommodations
and,
like
I
said
things
that
probably
I
personally
would
not
have
agreed
to,
but
the
stakeholders
in
the
work
group
that's
been
at
the
core
of
this
bill
were
willing
to
agree
to.
I
want
to
remind
everybody.
G
This
is
not
medicare
or
medicaid
funded
patients.
None
of
this
is
state.
These
are
all
private
dollars.
So
these
are
folks
who,
if
I
have
my
mom
in
a
facility
like
this
and
I'm
paying
a
lot
of
money
per
month,
and
it's
a
lot
of
money
in
private
pay
and
they're
doing
a
lousy
job
tomorrow
I
show
up-
and
I
move
my
mom
and
I
go
somewhere
else
where
I'll
pay,
my
good
earned
money
to
somebody
else.
So
the
ultimate
arbiter
of
good
care
are
the
people
that
are
paying
for
these
services.
G
It's
not
the
state.
It's
not
medicare.
There
is
no
public
money
coming
to
this
at
all.
We're
injecting
now
with
people
like
the
ombudsman
agency,
which
is
frankly,
a
federally
required
agency
of
oversight
to
the
state
to
oversee
private
pay
model
care,
which
I
have
a
bit
of
a
concern
with,
especially
when
we
have
no
oversight
over
the
ombudsman
agency.
State
of
kentucky
can
do
nothing.
If
you
have
a
complaint,
you
have
to
go
to
the
federal
government
to
file
that
complaint
and
have
those
issues,
but
we're
giving
an
agency
oversight
over
private
pay
facilities.
G
Again,
I
wouldn't
have
agreed
to
that.
The
stakeholders
have
agreed
to
that.
I'm
willing
to
go
with
that.
To
get
this
bill
to
the
point
that
it's
gotten,
so
a
lot
of
things
have
been
accomplished
at
this
point,
I
think
what
we
have
before
is
the
bill
that
I'm
willing
to
consider
the
other
options
to
say
just
scrap
it
and
we
go
back
to
square
one
where
we're
at
which
I
don't
think
is
a
good
place.
I
think
we
need
to
modernize
this.
G
C
C
H
I
don't
believe
that
that's
a
correct
number
there
may
be
90
licensed
personal
care
buildings
that
fall
under
this,
but
they
don't
all
have
secured
dementia
care
units.
I
don't
believe,
but
in
any
event
they
will
in
terms
of
level
of
care
those
secured
dementia
care
units.
Those
buildings
are
essentially
a
lateral
yeah.
H
Okay,
now
the
assisted
living
part
of
this
yes
they're,
going
from
being
a
social
model
where
people
who
can't
articulate,
generally
speaking,
can't
articulate
their
own
needs
if
they're
in
a
secure
dementia
care
unit,
they're
not
usually
going
to
be
able
to
have
the
conversation
with
their
physician.
That
really
needs
to
be
had,
and
that's
the
reason
why
this
bill
says
we're
not
going
to
have
any
more
social
model
secured
dementia
care
units,
we're
going
to
say
you
have
a
choice
in
your
general
population,
folks
that
don't
live
on
those
kinds
of
units.
H
You
have
your
choice
as
to
whether
or
not
to
add
those
basic
health
services
as
a
provider,
you
have
that
choice,
but
if
you
have
existing
building
or
new
building,
if
you
have
a
secure
dementia
care
unit,
you
will
offer
basic
health
services.
Your
staff
will
be
able
to
be
the
advocate,
the
expresser
of
the
needs
of
that
resident
who
can't
communicate
for
themselves
with
for
themselves
with
their
own
care
practitioner.
H
A
P
N
A
A
A
N
A
F
L
Sensitive
emergencies
is,
of
course,
heart
attack
and
of
trauma,
stroke
and
heart
attack,
treated
and
transported
by
ems.
Only
heart
attack
doesn't
have
designation
legislation
in
kentucky,
so
this
legislation
is
similar
to
what
we
did
with
stroke
legislation
in
2010
and
with
kentucky
being
one
of
the
states
leading
the
nation
in
heart,
attack
and
heart
disease.
This
bill
is
simply
about
improving
the
quality
of
care
and
saving
lives.
L
Right
now,
there
are
currently
25
27
certified
and
accredited
heart
attack
centers
here
in
kentucky
and,
as
I
said,
we're
trying
to
make
this
similar
legislation
to
the
stroke
legislation
2010
and
in
2008.
There
were
six
certified
stroke
centers
in
kentucky
since
that
bill
passed
in
2010.
There
are
now
41
and
due
to
that
hospital
hospital
mortality
has
decreased
from
11.7
to
3.6
and
being
discharged
to
home,
has
increased
from
28.4
to
48.
L
This
legislation
came
as
part
of
the
kentucky
heart
disease,
stroke,
prevention
task
force,
which
is
made
up
of
the
american
heart
association,
cardiologists
association,
the
cabinet
of
health
and
family
services,
american
association
of
critical
care,
nurses,
preventative
cardiac
cardiovascular
nurses,
association
and
the
american
association
of
heart
failure.
Nurses.
This
is
a
federally
funded
task
force
and
for
the
past
six
years
this
has
been
one
of
their
top
recommendations.
A
O
O
A
Q
F
C
F
A
L
A
P
Thank
you,
chairwoman,
moser
and
committee,
such
a
distinguished
and
awesome.
Looking
group
of
people
look
forward
to
presenting
this
bill
today.
Thank
you
for
your
time
today
we're
going
to
be
talking
about
a
compassionate
patient
support
bill.
This
is
this
is
a
bill
that
the
medical
community
has
brought
to
the
forefront
as
as
a
need
for
patient
support.
C
A
K
F
L
A
A
P
And
I
would
like
to
thank
these
presenters
here
also
for
their
expert
testimony
today.
I
feel
like
we're
in
the
two
minute
drill,
so
we'll
get
right
to
it.
This
bill
creates
a
mandate
for
doctors
that
they
will.
They
must
review,
interpret
and
release
critical
medical
information,
specifically
certain
tests
within
72
hours
after
receiving
the
results,
and
I
would
like
to
kind
of
hand
off
to
give
a
reason
why
this
bill
is
necessary.
K
K
K
The
21st
century
cures
act
was
passed
and
it
codified
the
fact
that
people
own
their
own
medical
data,
we're
fully
in
support
of
that
and
frankly,
have
been
petitioning
for
that
for
many
years.
However,
one
of
the
unintended
consequences
of
the
21st
century
cures
act
is
that
patients
now
receive
their
results
prior
to
their
physicians
and
their
clinicians.
K
You
can
see
that
this
causes
a
lot
of
angst
amongst
our
patients,
and
it
removes
the
patient
physician
relationship
where
we're
a
trusted
advisor
and
counselor
and
give
people
hope
in
the
times
that
they
need
it.
The
most
we
are
asking
for
a
very
specific
limited
exemption
to
give
our
physicians
and
our
clinicians
72
hours
on
tests
that
have
a
realistic,
meaningful
chance
of
having
bad
or
tragic
news.
K
F
K
Yes,
ma'am,
so
we're
chief
medical
information
officers,
so
finalize
is
an
important
way
for
us
to
operationalize
the
material.
So
there's
a
preliminary
reading
on
most
pathology
and
radiology
and
then
it's
finalized
after
the
physician
can
really
look
at
the
information.
Generally,
that's
within
a
12
to
24
hour
period,
but
it's
very
important
not
just
give
them
the
first
impression,
but
to
give
them
the
actual
final
result.
A
N
N
K
A
C
F
C
N
I'd
like
to
make
a
comment,
I
had
six
med
students
in
my
office
this
morning
and
all
six
of
them
are
thrilled
to
death
by
this
bill,
many
of
whom
were
raised
in
families
that
one
of
the
parents,
or
both
were
doctors
and
they're,
really
relieved
about
this.
Thank
you
very
much
for
for
bringing
this
bill
before
us,
and
I
vote
yes,
representative.
A
A
F
R
R
A
R
R
Thank
you
manager,
committee
members.
We
also
have
quite
a
few
stakeholders
behind
us
that
that
are
available
to
ask
any
questions
you
might
have
as
we
go
through
this.
I
do
want
to
thank
the
committee
and
appreciate
your
patience
and
understanding
as
the
13
stakeholders
work
out
many
issues
in
terms
of
where
we
are
with
house
bill.
R
777,
that's
right,
13
associations,
everybody
or
everyone
worked
and
working
on
the
house
bill
77
is
the
best
interest
of
patients
in
receiving
the
quality
care
and
that's
our
foremost
focus
in
terms
of
going
through
this
very
long
process.
I
can't
tell
you
the
number
of
hours,
women
and
men's
hours
that
have
gone
into
the
final
product
of
house
bill
777,
I
suspect,
to
probably
north
of
a
thousand
hours
total
that
people
put
forth
and
having
this
come
to
fruition.
R
R
Let
me
cover
the
purpose
of
the
bill
for
many
years
in
dealing
with
the
transportation
of
patients
between
healthcare
facilities
has
become
very
sensitive
and
problem,
problematic
issue
without
a
whole
lot
of
movement
movement
for
the
past
several
years.
But
this
bill
today
helps
answer
some
of
that.
At
least
it
moves
the
ball
forward
to
solving
those
that
ish
those
issues
we're
very
mindful
of
how
911
calls
are
handled
while
addressing
those
calls
that
might
not
be
classified
as
9-1-1,
but
are
time
sensitive.
R
Here
are
some
of
the
main
provisions
of
the
bill.
First,
during
our
discussions-
and
there
have
been
quite
a
few
of
them-
we
found
many
pertinent
issues
that
need
needed
to
be
addressed
but
needed
more
time
to
study
and
debate
them.
Given
this,
this
bill
establishes
a
legislative
task
force
to
act
during
the
interim
to
study,
delivery
of
ems
services,
develop
findings
and
recommendations,
and
then
report
back
to
the
general
assembly
two.
It
addresses
patient
outcomes
and
ems
delivery
services.
R
My
concern
is
always
two
things.
One
are
we
and
how
will
we
improve
the
product
of
the
service
and
then
two
taking
care
of
the
employees
and
this
bill?
We,
we
believe,
addresses
the
objective
by
having
a
very
safe
landing
for
personnel
handling
the
funds,
equipment,
records
and
supplies,
while
improving
the
quality
of
care.
R
In
addition
to
that,
this
bill
also
looks
at
the
makeup
of
k-beams
four.
It
provides
the
cabinet
of
health
and
family
services
complete
access
to
all
data
and
records
maintained
by
k-beans
and
its
contractors
by
by
combining
this
data
bank
with
a
cabinet,
better
analysis
of
runs
coverage,
types
of
calls,
geographical
reach
and
many
other
factors
will
provide
better
measurements
that
will
help
regulations
and
service
five.
R
S
S
S
S
D
D
A
little
bit
naive
on
certificate
of
needs,
I
tell
you
what
I've
learned
a
whole
lot
in
the
past
past
few
weeks
about
about
the
way
that
process
works,
but
I
I
want
to
I
do
want
to
thank
representative
fleming
representative
hart
and
chair
moser
for
the
work
that's
occurred
over
the
course
of
not
only
this
session
but
but
over
the
course
of
the
past
several
several
years
in
in
this
discussion
on
on
what
could
be
controversial
topics,
you
know
it's
always
better.
You
always
end
up
with
a
better
piece
of
policy.
D
If
you
have
an
opportunity
to
hear
the
perspective
of
so
many
different
organizations,
and
in
this,
in
this
instance,
we
talked
to
everybody.
The
hospital
association
worked
with
groups,
we
worked
with
group
was
our
fire
chiefs
and
our
firefighters,
who
had
expertise
to
bear
on
this
issue,
but
I
will
agree
completely
with
both
representative
fleming
and
and
nancy,
with
galvani,
with
the
hospital
association
to
say
there
is
work
to
be
done.
D
Still,
there
always
will
be
work
to
be
done
when
it
comes
to
taking
care
of
your
constituents
from
a
patient
perspective.
That
work
will
never
ever
end,
but
there
is.
There
is
work
to
to
be
done
and
discussion
to
be
done
with
regard
to
the
way
we
certify
personnel
and
and
look
at
the
way
we
train
through
the
k-beams
process.
D
D
Here
in
frankfort
that
that
that
was
being
blocked,
and
so
they
could
not
respond,
and
so
my
board
put
on
our
agenda
to
pursue
legislation
that
would
give
us
an
exemption
for
from
the
c-o-n
process.
This
bill
addresses
that,
right
now
we
got
to
be
able
to
enable
our
local
elected
officials
to
serve
their
citizens,
especially
in
situations
like
prestonsburg,
where
my
mayor
testified
from
there.
D
My
mayor,
the
mayor
of
prestonsburg,
on
my
board
of
directors,
testified
about
hour-long
weights
and
you've
heard
all
those
stories
and
so
frustrating
for
an
elected
city
official
to
be
able
to
tell
their
constituent
there's
nothing.
I
can
do
about
that.
So
this
legislation
addresses
that
that
that
certificate
of
need
process
and
it
empowers
it
and
tackles
it
from
a
local
government
perspective.
D
Local
leaders
know
these
these
needs.
This
is
a
sound
bill
with
sound
policy
that
moves
this
ball
forward
significantly
for
the
citizens
of
the
commonwealth,
protects
their
personnel
that
provide
these
services
and
sets
the
stage
for
for
bigger
discussions,
and
I
can't
more
enthusiastically
urge
you
to
support
passage
of
house
bill.
777.
R
R
I
just
want
to
say
that
one
thing,
as
we
mentioned
that
we
are
this,
took
a
lot
of
coordinated
effort.
It
took
a
lot
of
time
and
effort,
but
I'll
end
with
this,
where
I
began
is
that
east
association
begins
with
the
word
kentucky
and
this
might
be
a
little
cliche
a
little
dorky,
but
I
think
it
really
is
really
says
something
I
think
about
this
group.
A
A
E
E
A
P
A
P
A
P
P
We
think
it's
a
reasonable
compromise
on
a
whole
lot
of
things.
It
provides
good
stability
for
letting
the
folks
that
know
about
ems
continue
to
regulate
ems,
as
well
as
a
reasonable
change
of
the
complaint
process,
and
it
recognizes
that
we
don't
think
we're
done
and
that
we
can't
walk
away
with
this
being
the
only
ems
built
that
any
of
us
ever
think
of,
because
there's
still
a
lot
of
work
to
be
done.
So
I
think
that
legislative
task
force
and
the
k-beam
special
committee
on
it
are
super
important
and
great
parts
of
this
bill.
P
Our
providers
have
asked
us
to
add
one
small
request,
and
that
is,
as
things
go
through,
possibly
consider
the
addition
of
an
ems
provider
nominated
by
kemsa
for
both
the
ems
for
the
board
of
ems,
as
well
as
that
task
force
to
continue
to
represent
ems
providers
specifically,
but
otherwise
we
again
think
this
is
a
good
bill
and
we
support
it
and
I
think,
with
just
a
very
small
change.
It
can
be
even
better.
So
thank
you
very
much
for
your
time.
P
Madam
chair,
thank
you
to
all
the
representatives
for
the
time
today.
My
name
is
ryan
stanton,
I'm
a
board
certified
emergency
physician
and
board.
Certified
ems.
Physician.
Interestingly,
with
the
specialty
of
ems,
you've
got
approximately
twenty
percent
of
the
board
certified
ems
physician
sitting
at
this
table
right
now.
P
I
think
it's
very
important
that
we
continue
to
separate
the
911
service
to
ensure
that
our
paramedics
and
ems
professionals
are
at
the
bedside
as
quickly
as
possible
in
lexington,
where
I'm
the
medical
director
we're
not
satisfied
with
not
being
at
a
patient's
bedside
in
10
or
15
minutes.
We
look
at
five
to
eight
minutes.
Is
the
time
from
that
time
drop
that
call
drop.
So
I
want
somebody
at
that
bedside
on
that
street
or
wherever
that
patient
is
so.
We
need
to
continue
to
support
that.
P
We
also
need
to
separate
out
those
private
or
whoever
is
doing
inter-facility
transfers
and
also
support
the
process
for
hospital-based
ems,
as
we
call
it
transport
services
to
ensure
that
they
can
provide
and
transport
those
patients
that
need
to
be
elsewhere
as
we
move
forward.
I
would
strongly
encourage
that
the
task
force
and
those
that
work
on
the
legislation
recommendations
moving
forward
represent
the
specialty
and
profession
of
emergency
medical
services.
This
is
not
something
that
everybody
can
do.
P
This
is
something
that
takes
special
focus:
special
education,
even
for
us,
both
of
us
at
this
table
being
board
certified
in
emergency
medicine
was
not
enough
and
we
felt
it
was
necessary
to
continue
to
advance
our
education
and
training
to
be
able
to
provide
the
best
services
for
our
paramedics
for
our
emts
and,
most
importantly,
for
our
patients.
So
as
we
move
forward,
I
strongly
encourage
to
work
closely
with
those
professionals
that
are
boots
on
the
ground
to
provide
the
care
for
those
across
the
commonwealth
and
beyond.
Thank
you.
A
Thank
you
so
much
for
being
here
as
a
former
flight
nurse,
I
really
appreciate
the
work
that
all
of
you
do
everyone
in
this
room.
I
understand
the
patient
care
that
takes
place
and
the
and
the
needs
of
the
patients
stabilization
in
the
field.
It's
not
an
easy
job,
it's
an
exciting
place
to
to
work
sometimes,
but
it's
also
very
stressful,
and
I
just
want
to
again
thank
everyone
for
all
of
your
work
on
this.
A
We,
my
job
is
to
ensure
that
patients
get
the
care
that
they
need
in
the
commonwealth
and,
however
that
happens.
We
are
facilitators
of
the
process
and
I
just
want
to
say
a
lot
of
work
has
gone
into
this
donna
little.
We
could
not
have
done
this
without
you
and
deanne.
Thank
you
so
much
for
your
work
on
just
making
sure
that
we
get
the
language
right.
A
F
My
name
is
jim,
duke
I'm
with
the
kentucky
ambulance
providers,
association
and
we're
here
today
in
support
of
house
bill.
777
we've
worked
very
closely
with
everyone
over
several
months
of
going
back
into
the
to
the
committees
that
met
last
year,
trying
to
acknowledge
and
and
figure
out
how
to
fix
the
patient
transport
problem,
just
like
our
our
friends
in
the
hospitals
and
in
long-term
care
we're
experiencing
one
of
the
worst
staffing
shortages
that
we've
seen
in
our
career.
F
F
Everybody
did
to
try
to
come
up
with
something
that
we
we
all
felt
was
moving
forward
on
better
patient
care
and
that's
all
I've
got
unless
there's
any
questions.
Thank
you,
and
I
want
to
thank
representative
moser
and
representative
fleming
for
all
the
work
and
and
open-mindedness
you
all
have
had
to
help
us
facilitate,
as
you
said,
to
make
this
work.
Thank
you.
I
I
I
believe
that
health
care
begins
on
the
street
at
the
home
at
the
car
wreck,
and
I
appreciate
representative
fleming
for
working
through
this
bill.
There's
been
a
lot
of
conversation,
particularly
over
the
last
couple
of
weeks.
I
would
ask
that
the
kentucky
county
judge
executive
association
have
a
seat
at
the
table
as
the
task
force
moves
forward
when
someone
can't
get
transported
from
harlan
arh
to
university
of
kentucky
medical
center,
the
county
judge
executive's
getting
a
lot
of
those
calls.
Dr
brandman
spoke
to
that
she's
exactly
right.
This
happens.
I
I
That,
what's
going
to
happen,
is
that
we're
going
to
have
folks
that
need
transported
to
another
facility
by
ambulance
and
it
is
going
to
take
away
from
people
who
are
calling
9-1-1
that
are
already
waiting,
sometimes
30
and
45
minutes
up
to
an
hour
to
get
transported
to
a
hospital
when
they're
having
a
heart
attack.
There's
such
a
shortage
of
personnel
in
this
industry
right
now
that
this
is
a
major
crisis,
we've
been
talking
about
it
for
a
long
time.
I
It's!
I
worry
that
you
know
a
lot
of
a
lot
of
the
folks
that
were
in
this
industry
have
transitioned
out
into
work
to
work
into
hospitals
in
2021
out
of
4
000
registered
paramedics
in
kentucky.
Only
1200
responded
to
ground.
Ambulance
runs
that's
30
percent.
If,
if
30
of
the
physicians
had
showed
up
in
the
hospitals
during
the
last
year,
where
would
we
be
with
this
shortage?
I
I
I
The
number
one
issue
facing
our
communities
is
ems
and
it's
very
broad.
It's
a
very
broad
situation.
There
are
some
that
are
county
brand
ambulance
services.
There
are
some
that's
operated
through
the
taxing
district.
There
are
some
that
are
operated
by
a
private
ambulance
service
and
there
are
some
that
are
operated
by
cities,
but
the
common
theme
is
the
shortage
of
personnel
that
are
working
in
this
particular
sector
of
emergency
emergency
response
going
out
to
take
care
of
the
folks
that
need
it.
I
Like
I
said,
I
agree
with
dr
brandman,
we
hear
the
same
thing.
The
hospital
to
hospital
transports
are
another
major
major
issue.
We
recognize
that
we
get
that
call
to
all
of
these.
Folks
are
our
citizens.
They
all
need
air
assistance,
I'm
afraid
there
will
be
unintended
consequences
with
this
particular
bill.
I
would
ask
that
we
take
a
look
at
it
further.
We
slow
it
down.
Many
of
my
constituents
haven't
even
seen
the
bill.
It
came
out
tuesday
night.
I
The
goal
has
to
be
what
we
can
effectively
do
that
improves
the
service
to
our
citizens,
not
only
those
that
are
in
the
hospital,
but
those
that
are
at
home
that
need
to
call
9-1-1
and
expect
and
deserve
that
that
ambulance
gets
there
to
help
them
until
we
address
the
human
shortage
element
in
this
industry.
I'm
afraid
efforts
like
this
will
have
unintended
consequences
I'll
end
by
saying,
as
a
judge
executive,
knowing
what
exists
on
the
local
level.
I
A
Thank
you
if
I
could
just
address
a
couple
of
your
points
before
we
move
on
to
judge
buchanan,
I
just
want
to
reiterate
that
this
is
a
starting
point.
This
is
solving
a
a
crisis
right
now
and
we
have
the
opportunity
in
this
task
force
to
really
take
on
the
more
difficult
issues
and
absolutely
have
you
as
your
your
association,
represented
on
in
any
further
conversations
the
the
issue
of
staffing
and
retention,
recruitment,
training,
that's
a
separate
conversation.
It
isn't
addressed
in
this
bill.
A
We
fully
recognize
that
staffing
is
an
issue
we're
having
conversations.
This
is
a
budget
year
about
potentially
having
training
dollars
inserted
into
the
budget.
We
know
that
we
need
to
expand
our
pipeline
of
health
care
workers,
including
ems
and
paramedics.
So
I
appreciate
your
comments
very
much.
Thank
you
for
being
here.
Thank.
T
You
judge
buchanan.
Thank
you
very
much,
madam
chairman.
I
appreciate
all
the
work
that
you
and
representative
fleming
and-
and
this
committee
has
done,
along
with
all
the
people
throughout
the
state-
it's
it's
absolutely
necessary
to
address
these
problems,
I'm
just
here
as
one
of
those
people
that
doesn't
have
that
problem,
and
I
my
my
concerns,
are
reflective
of
judge
mosley's
as
well.
T
They've
done
exactly
that.
They've
they
agreed
to
grow
with
the
community.
They
had
about
50
about
50
employees
in
1994.
When
I
took
office
now
they
have
a
hundred
employees
in
the
ambulance
service
area.
They
have
13
ambulances
that
they
run,
they
do
an
outstanding
job
and
their
their
time
for
showing
up
on
the
scene
is
less
than
the
state
average.
T
T
But
my
concerns
are
the
staffing
shortage,
which
judge
mosley
so
well
articulated,
but
this
has
been
the
first
time
this
isn't
the
first
time
we've
had
a
staffing
shortage,
but
we've
continued
to
grow.
The
medical
center
actually
teaches
ems
classes
and
certifies
certifies
different
ems
for
their
for
their
own
training
and
for
their
competing
hospital
as
well.
T
They
teach
nursing
classes,
they
have
the
wku
nursing
school
there
on
campus
at
medical
center.
They
also
have
the
uk
medical
school
there
on
campus
at
med
center
health,
they're
they're
a
growing
entity
that
is
doing
a
great
job.
For
the
past
several
years,
I've
had
greenview
hospital.
Who
is
the
other
hospital
in
our
community,
which
is
a
good
company
with
tristar
and
we're
proud
to
have
both
hospitals
in
our
community,
but
they
keep
insisting
that
the
reason
they're
they're
not
doing
as
much
business
is
because
of
the
medical
center?
Has
the
ambulance
service.
T
T
I
can
see
this
going
to
to
to
cost
my
citizens
a
great
deal
of
money
and
there
have
been
two
people
that
have
actually
been
the
administrators
of
the
medical
center
at
bowling
green.
There
have
probably
been
10
at
greenview
and
each
time
they
they
decide.
They
want
to
do
something
because
it
looks
like
a
competitive
thing
to
do.
A
A
A
A
N
I've
had
the
privilege
of
last
saturday.
I
sat
next
to
an
ambulance
driver
in
a
rural
county
for
about
an
hour,
and
I
learned
how
why
he
went
into
the
business
how
much
he
was
making,
which
was
ten
dollars
an
hour.
What
the
competition
is
who
owns
it
and
it
was
really
quite
an
eye-opening
experience
and
one
night
I
I
returned
a
phone
call
to
a
flight
ambulance
driver
and
he
was
a
very
interesting
person
to
visit
with
and
and
talk
about
his
experience,
the
training.
E
I
have
several
questions,
but
I
know
we're
limited
on
time.
My
questions
for
representative
fleming,
looking
at
the
makeup
of
the
task
force
members
on
pages
57
through
60,
I
noticed
that
the
kentucky
professional
firefighters
were
not
included,
knowing
that
firebase
ems
systems
are
the
biggest
provider
of
ems
in
the
state.
E
H
E
E
F
Just
a
comment,
thank
you,
madam
chair.
I
just
want
to
thank
you,
representative
fleming,
for
including
house
bill
151,
the
attack.
I
know
my
constituent,
troy
walker,
is
the
president
of
kappa
and
he's.
We've
had
many
conversations
and
he
says
that
reimbursement
is
a
big
issue
and
I
believe
that
will
help
move
the
ball
forward
on
that
issue.
So
thank
you.
Q
It
treats
the
entire
county,
and
so
even
though
it
might
just
be
located
in
the
city-
and
I
don't
want
to
you
know-
I
don't
know
how
we
worded
it.
I
don't
want
to
put
something
in
place
where
you
know
we're
not
giving
the
city
the
ability
to
treat
its
citizens,
but
that
hospital
treats
the
entire
county
and
sometimes
an
entire
region,
and
so
a
decision
that
a
city
government
can
make
would
affect
the
county
would
affect
the
citizens
in
the
county,
and
you
know
I
represent
all
the
citizens
of
the
county.
D
May
I
respond
sheriff,
I
I
appreciate
that
I've
heard
that
heard
that,
from
from
some
of
the
folks
out
in
the
hall
before
this,
before
this
meeting
and
I'll
tell
you
both
the
judges
here,
they
have
immense
respect
for
for
both
of
those
especially
judge
buchanan,
who's,
who's,
who's
kind
of
the
the
dean
of
the
delegation
and
local
government,
even
even
over
cities.
So
but
representative
boland
to
address
address
you
directly
just
to
be
abundantly
clear
about
what
the
bill
does.
D
D
That's
not
how
that
works.
So
so,
if
the
city
or
county,
depending
on
where
the
hospital
is
located,
makes
a
sign
off
on
on
that
non-sub
review
process.
You've
got
that
hearing.
In
addition,
after
that
process,
as
a
practical
matter,
we
had
this
vigorous
discussion
with
the
hospital
association
going
through
as
a
practical
matter.
It's
a
city
and
county
governments
that
controlled
this
batch
you're
not
going
to
have
a
hospital.
D
So
I
I
just
don't.
I
don't
see
this
as
a
territorial
battle
that
that
may
be
be
characterized.
I
don't
think
it
is.
I
think
I
think,
in
large
part,
throughout
the
commonwealth
of
kentucky
city
and
county
governments
are
working
collaboratively
together
in
the
best
interest
of
their
of
their
constituency,
and
so
I
hate
to
see
any
kind
of
impression
that
it's
a
city
v
v
county
issue,
on
that
most
of
this
is
collaborative
a
collaborative
process.
A
Thank
you
so
much
I
I
couldn't
agree
more.
We've
worked
hard
to
make
sure
that
it
is
collaborative,
and
you
know
we'll
we'll
have
issues
I'm
sure
to
iron
out
as
we
go
forward
and
that's
why
we're
very
intentionally
putting
this
task
force
in
place.
Representative
sheldon.
Do
you
have
a
quick
comment.
C
Yeah
just
quickly,
I
I
want
to
just
take
a
little
bit
of
exception
to
how
I
think
somebody
mentioned
that
it
was
rushed
through.
I
kind
of
find
that
almost
comical
since
four
years
ago
I
can
remember
many
hours
sitting
in
chairwoman,
moser's
office
late
at
night,
with
stakeholders
discussing
this
very
issue
and
then
going
down
the
hallway
the
following
year
with
another
whole
different
legislator
that
represented
this
thing,
and
it's
just
year
after
year.
C
So
for
four
years,
I've
watched
this,
and
I
think
this
is
a
great
first
step
for
the
hospital
association
to
step
in
and
to
to
kind
of
be
the
foundation
that
we
operate.
This
task
force
on
and
chairman
moser
and
representative
fleming.
You
guys
have
done
a
great
job,
putting
it
together
and
I
just
want
to
say
it's
been
a
long
haul
and
and
thank
you
very
much
and
looking
forward
to
the
next
step.
So
thank
you
very
much.
Q
Bowling
I'm
gonna
vote
no.
Today.
I
too
hope
that
there
can
be
more
discussion.
I've
got
several
concerns.
Obviously
judge
mosley's
from
harlan
county
testified
before
us
today,
but
it's
not
just
him.
I've
had
several
other
city
and
county
officials
reach
out
to
me
on
this.
So
hopefully
we
can
work
through
that.
F
Explain
my
vote.
Please
sure
I'm
a
yes,
so
I
represent
rock
castle
county
as
one
of
mine
very
rural
county.
We've
got
a
great
ems
service
there,
but
they
couldn't
do
inter-hospital
transfers
because
they
were
losing
money.
So
every
time
they
were
having
to
go
to
lexington,
you
know
they
might
be
gone.
Six
eight
hours
a
day
didn't
have
the
personnel
that
they
could
justify
that
transfer.
So
the
the
hospital
back
home
went
through
the
c-o-n
process,
extremely
expensive,
extremely
needed
extremely
time.
F
Consuming
the
local
ems
was
fully
supportive,
but
it
still
had
they
still
had
to
go
through
all
of
those
and
check
all
those
boxes.
Meanwhile,
the
people
were
kind
of
suffering,
so
I'm
a
yes.
I
think
this
is
a
great
great
first
step.
You
know
this
bill
has
come
a
long
way,
I'm
glad
to
see
the
task
force
there.
F
F
May
explain
my
vote.
I
apologize
for
missing
the
discussion.
I
had
some
other
business
to
attend
to
I'm
going
to
vote
yesterday
to
move
this
forward.
I
think
that
the
task
force
is
a
great
idea,
but
I
do
have
some
concerns
that
this
might
shift
costs
to
local
governments
and
those
are
the
concerns
that
have
been
expressed
to
me
by
my
county
and
by
the
ems
director
there.
So
I'm
going
to
vote
yes
to
advance
it,
but
I
may
very
well
oppose
it
on
the
floor.
Thank
you.
F
Briefly
explain
my
vote.
I
completely
understand
the
concerns
that
judge
executive
buchanan
had
and
the
possible
unintended
consequences
that
could
impact
warren
county.
I
consider
judge
buchanan
to
be
the
gold
standard
of
county
judge
executives
in
the
state
and
completely
understand
that
that
part
of
it
I'm
going
to
vote
yes
to
get
it
out
committee.
I
commend
representative
fleming
for
a
lot
of
hard
work
because
he's
made
this
bill
better.
Every
time
they've
they
filed
it
and
I
appreciate
his
work,
but
I
do
have
those
concerns.
Thank
you
very
much.
F
C
F
N
J
R
N
I'd
like
to
explain
my
vote,
I
think
you've
really
opened
a
very
delicious
can
of
worms,
and
I
I
hope
I
will
vote
yes
for
this,
because
I
think
this
is
a
task
force
that
really
deserves
to
represent
all
facets
of
the
industry.
There's
so
much
so
many
of
us
don't
have
a
background
in
this
and
we
need
to
know
from
the
ground
up
how
it
works
in
different
locations
and
and
why
there's
a
lag
time
why
people
are
waiting.