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From YouTube: Senate Standing Committee on Health and Welfare (2-2-22)
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A
A
Here
very
good,
we
have
a
quorum,
we're
established
to
do
business.
We
have
four
bills
on
the
agenda.
Let's
start
first
with
senate
bill,
87
we're
going
to
go
ahead
and
pass
over
that
bill
here
today,
we'll
probably
be
hopefully
addressing
that
at
some
point
in
the
future.
A
We're
waiting
on
some
information
on
the
fiscal
note
which
we
just
got
yesterday,
so
we're
going
to
pass
over
that
bill.
The
next
item
on
the
agenda
is
senate
bill,
97,
an
act
relating
to
child
fatalities
and
near
fatalities
to
sponsor
senator
danny
carroll,
senator
if
you'd
like
to
come
to
the
table,
and
if
you
have
any
guests,
if
they
could
introduce
themselves
and
begin
your
testimony
whenever
you're
ready.
D
D
However,
what
we
failed
to
do
at
that
time
was
to
ensure
that
we
were
making
the
most
out
of
their
work
to
to
make
sure
that
there
was
accountability
built
into
the
recommendations
that
the
panel
made
upon
review
of
these
cases
made
a
commitment
that
day
to
work
with
the
panel
to
create
a
piece
of
legislation
to
address
some
of
these
issues.
And
that's
why
we're
here
today-
and
I
think
at
this
point
I
will
yield
to
mr
shannon-
and
let
him
give
you
just
a
little
background
on
the
panel's
work.
E
Again,
the
child
fatality
or
fatality
external
review
panel,
we
review
cases
involving
children
who
have
died,
dcbs,
maybe
public
health
referrals
or
have
been
injured,
and
we
looked
at
in
our
last
year
of
debt,
full
data.
We
looked
at
200
cases,
80
of
those
involved
fatalities,
100
involved
near
fatal
120
near
fatalities.
E
E
We
have
other
volunteers
who
participate
and
we
come
together
and
really
I
do
a
lot
of
meetings.
You
know
my
children
when
they
were
younger,
said
I'd
lead
the
league
in
meetings.
This
is
the
worst
activity
I
I
am
involved
with
my
wife
knows
when
I've
had
a
child
fatality
near
fatality
meeting
that
day,
it's
really
hard
work.
The
staff
is
really
they
go
through
cases
of
awful
things
of
what
takes
place
and
we
review
them
and
and
the
motivation
is
to
identify
trends
data.
What
can
we
use
moving
forward
to
maybe
address
some
problems?
E
We're
hoping
that
something?
This
becomes
a
preventative
strategy
and
we
make
things
better
for
kids
makes
things
safer
for
kids.
What
I've
learned
is
safe.
Sleep
is
a
real
problem.
I
don't
know
anything
about.
I
have
two
young
daughters
when
they
were
babies.
No
one
told
us
about
sleeping
with
your
baby.
I'm
going
to
confess
this
to
everyone
today,
our
oldest
daughter,
when
she
was
an
infant,
would
get
up.
E
In
the
middle
of
the
night
coughing
I
had
learned
to
hold
her
in
the
recliner
and
I
could
put
on
the
wizard
of
oz
and
she'd
be
quiet
and
when
she
got
fidgety,
I
could,
in
my
sleep,
rewind
it
and
put
her
back
to
sleep
that
is
unsafe
sleep.
We
didn't
know
that
this
is
what
the
panel
talks
about,
and
we
talk
about
those
things.
A
lot
we
talk
about.
Families
are
really
tough
places
and
bad
things
that
happen
to
kids
for
a
lot
of
different
areas.
I
think
it's
important
work.
E
I
think
it's
invaluable
work
and
it's
just
sharing
that
information
and
we
pass
it
on
the
dcbs.
We
want
to
partner
with
ecbs.
They
have
a
really
hard
job.
We
don't
want
to
be
argumentative
with
dcbs,
but
we
share
that
information
and
that's
what
we
do
and
we
meet
once
a
month.
So
every
whatever
tuesday
afternoon
for
four
hours,
we
go
over
these
cases
and
talk
about
awful
things
that
happen
to
kids
in
kentucky
that,
hopefully
we
can
stop
talking
about
those
at
some
point
is
really
the
objective.
A
D
The
bill
also
requires
that
the
president
of
the
coroner's
kentucky
coroner's
association
and
a
practicing
medication,
assisted
treatment
provider,
be
selected
by
the
ag
from
a
list
of
three
provided
from
the
kentucky
board
of
medical
licensure,
and
these
two
positions
be
added
to
the
panel.
This
is
two
areas
of
expertise
that
the
panel
members
indicated
that
the
chair
indicated
would
be
of
value
to
the
panel
in
the
reports
that
they
review.
D
D
The
agency
has
90
days
to
respond
in
writing,
specifying
their
intent
to
implement
the
recommendation
in
an
approximate
time
frame
or
reply
with
the
notice
that
the
agency
does
not
intend
to
implement
the
recommendation
and
an
explanation
of
why
they
can't
so
so
many
times
there
have
been
recommendations
made,
and
basically
they
just
go
nowhere.
There
is
no
accountability
or
follow-up.
Sometimes
it
has
been
done
on
these
recommendations.
So
this
puts
some
credibility
and
some
accountability
into
the
the
recommendations
that
the
panel
makes.
D
That's
separate,
but
we
felt
like
it
was
a
good
idea
to
to
put
this
into
statute
to
give
protections
so
that
those
those
incidents
can
be
reviewed
and
conversations
can
be
freely
had,
without
fear
of
any
of
that
information
being
used
for
discovery.
D
The
yes
child
welfare
oversight
and
there's
some
combination
of
committees
that
will
be
made
felt
like
this
was
probably
the
best
avenue
to
get
the
ex
official
members
from
the
legislature
on
the
panel
on
the
the
part
of
the
bill
where
it
talks
about
someone
having
control
over
a
child
for
the
purposes
of
determining
blood
alcohol
or
are
getting
a
blood
test
urine
or
breath.
We
simply
added
the
word
parent
to
to
the
term
of
anyone
having
control
or
or
oversight
over
the
child.
D
The
request
of
one
of
the
board
members
and
the
addition
that
we
made
yesterday
was
a
recommendation
that
the
panel
had
that,
I
think,
is
a
very
important
recommendation,
something
that
really
needed
to
be
codified
and
that's
why
we
made
the
change
and,
under
this
recommendation
in
the
bill,
it
would
now
require
a
coroner
upon
notification
of
a
death
of
a
child
under
18
years
of
age,
to
report
the
death
to
law
enforcement,
dcbs
and
the
health
department
immediately
in
this,
as
opposed
to
as
soon
as
practicable,
as
is
currently
in
the
statute.
D
70
krs
72.410
and
the
purpose
of
that
contact
is
to
determine
the
existence
of
relevant
relevant
information
concerning
the
case.
So
from
what
I've
been
told
throughout
the
state,
through
some
coalition
meetings,
that
they've
discovered
that
sometimes
there
are
corners
waiting,
two
or
three
days
to
make
notifications
to
law
enforcement
or
dcbs
or
the
health
department
on
the
death
of
a
child
and
as
a
former
investigator,
that's
unacceptable.
D
The
the
possibility
of
any
type
of
investigation
two
days
later
would
be
almost
impossible.
These
these
cases
are
some
of
the
most
difficult
cases
that
an
investigator
would
work
and
the
the
availability
of
evidence
is
crucial
to
the
success
in
any
prosecution
and
if,
if
it's
two
days
later,
if
a
child's
body's
been
removed
without
a
detective
working
the
scene
obtaining
the
evidence,
it
could
have
a
major
impact
on
on
any
prosecution.
D
When
this
committee
was
established,
there
was
an
mou
between
this
panel
and
the
justice
cabinet
related
to
funding,
and
there
was
supposed
to
be
a
420
000
appropriation
that
goes
to
this
panel
for
the
function
for
for
personnel
in
in
the
other
functions
of
the
panel,
looking
at
the
funding
that
they
have
had
each
year.
D
This
was
never
put
in
line
item
and
it
has
fallen
fallen
short
each
year,
so
we
will
be
looking
at
language
in
the
budget,
a
line
item
that
will
fund
this
critical
panel
to
allow
them
to
be
able
to
function
at
their
highest
level.
I
can't
think
of
any
other
panel
that
we
establish
in
this
commonwealth.
That's
any
more
important
than
this,
and
as
an
investigator
having
having
these
levels
of
expertise,
reviewing
cases,
it
can
be
invaluable
in
the
way
we
conduct
training
for
our
law
enforcement,
our
investigators,
dcbs
folks.
D
Anyone
who
deals
with
these
types
of
deaths,
where,
where
there
may
be
some
suspicious
incident
surrounding
the
death,
it
could
be
critical
to
the
success
of
any
investigation,
and
it
would
allow
detectives,
would
allow
dcbs
folks
to
be
more
effective
in
their
role
when
you
have
this
level
of
expertise
reviewing
their
work.
So
it
is
a
positive
thing.
That's
the
approach
that
the
panel
takes
where
they
work
in
conjunction
with
these
folks
to
make
a
positive
relationship,
so
the
benefits
to
all
parties
is
at
a
high
level.
It's
not
an
adversarial
relationship.
A
Very
good,
thank
you.
Senator
appreciate
the
work
on
this.
I'm
a
member
of
that
panel,
and
it's
tell
you
that
it's,
I
think
the
way
you've
got
it
restructured
for
legislative
input.
I
think,
is
better.
It's
difficult
for
us
to
make
often
they'll
happen
during
proceedings,
while
we're
here
and
just
it's
very,
very
difficult
to
make
those
meetings.
I
think
this
will
provide
a
lot
more
legislative
input.
The
way
things
are
structured
as
well.
We've
got
a
couple
of
questions.
First,
one
is
from
senator
howe.
D
Senator
carol,
thank
you
for
bringing
this
in
section
5e1
about
the
the
subpoena
power.
If
there.
A
F
You
know
from
our
history
together
I
like
any
bill
that
builds
accountability
onto
the
system
and
I
really
like
the
the
provision
that,
once
a
recommendation
is
made
signed
to
academy,
there's
got
to
be
follow-up
because
again,
that's
where
things
fall
to
the
correct,
so
good
bill.
Only
question
I
have
and
simple
question
is
on
page
13
that
the
talks
about
the
publish
of
the
annual
report.
What's
the
motivation
for
movement
from
december
to
february,
what
are
we
trying
to
accomplish
there.
E
It's
difficult
to
to
get
our
work
done,
formalized
and
and-
and
the
case
is
reviewed,
so
that
gives
us
just
more
time
to
accomplish
that
and
because
you
know
this
past
year
it
was
submitted
to
february
1..
We
typically
asked
for
an
extension
anyway,
and
we've
done
that
last
several
years.
So
really,
this
change
is
consistent
with
the
practice.
F
D
I
think
this
piece
of
legislation
is
going
to
create
an
avenue,
a
direct
avenue
with
the
legislature
to
to
uphold
our
part
of
of
the
recommendations
where
whoever
is
sitting
on
the
the
panel
will
have
access
to
the
information.
And
then
you
know
they
can
start
looking
towards.
D
Whether
it
be
that
or
in
the
the
oversight
investigations
committee.
F
I
appreciate
that
because
I
think
I've
seen
a
shift
over
the
last
three
four
interim
sessions
that
we're
focusing
more
on
preparing
legislation
for
the
upcoming
session,
and
it's
not
just
dog
and
pony,
shows
that
we've
seen
in
the
past,
and
I
think
that's
why
the
interim
session
should
be
used
as
develop
legislation
to
be
heard
later.
So
I
appreciate
them.
Thank
you
for
your
answer.
Thank
you,
mr
chair.
A
A
Matter
passes
with
a
vote
of
11-0.
Congratulations
senator
this
will
be
reported
favorably
to
the
senate
floor.
Next,
on
the
agenda,
we
have
senate
bill,
105
an
act
relating
to
newborn
and
infant
screenings.
The
sponsor
is
senator
max
wise.
This
has
been
a
topic
that
was
filed
last
year.
We've
had
an
interim
discussion
on
this
issue
and
senator,
if
you'd
like
to
introduce
yourself
and
any
guests
that
you
have
and
please
begin
your
testimony.
C
Chairman
alvarado,
thank
you
members.
Thank
you
so
much
and
and
chairman
I
want
to
personally.
Thank
you
just
for
your
words.
This
is
a
bill.
As
we
filed
last
session,
you
were
very
amenable
to
working
with
us.
You
made
the
promise
that
this
topic
would
be
brought
up
during
the
interim.
Just
like
senator
meredith
said
the
use
of
the
interim.
Our
first
meeting
dealt
with
the
topic
that
we're
going
to
be
dealing
with
today
and
the
bill
list
before
you
and
senate
bill
105..
C
Mr
chairman,
there
is
a
committee
sub
and
if
I
could,
if
I
could
ask
you
to
to
to
move
for
adoption
on
that,
certainly.
A
C
Mr
chairman
members,
this
topic
is,
is
an
issue
that
many
of
you,
if
you
were
in
the
interim,
you
knew
the
story
about
the
truval
family
and
specifically
about
belladon
street
vol
and
a
constituent
of
mine,
the
family,
in
adair
county.
C
I
was
unaware
of
a
sadomegalovirus
as
most
commonly
known
as
cmv
before
even
coming
into
the
legislature.
I
hate
to
say
that
there's
many
issues
and
topics
that
we're
just
not
experts
on
or
knowing
about
but
reading
an
article
in
the
local
ladera
county
newspaper
brought
it
to
my
attention
and
that's
where
we
are
today
of
a
constituent
story
that
then
became
a
journey
and
presents
before
us
today
in
senegal
105..
I
would
like
for
my
guests.
They
would
introduce
themselves
for
the
record.
We
may
proceed.
I
J
Hello,
my
name
is
sarah
roof
and
I'm
representing
kentucky
hands
and
voices,
which
is
a
statewide
organization
that
supports
families
of
children
who
are
deaf
or
hard
of
hearing.
I
do
have
a
nine-year-old
son
who
is
deaf
not
related
to
cmv,
but
in
my
role
with
that,
I
have
had
the
honor
and
privilege
to
meet
so
many
families
across
kentucky
who
are
impacted
by
cmv,
and
that,
of
course
includes
sarah
and
her
family.
We
also
have
cameron
who
is
here
with
us.
J
He
has
been
impacted
by
cmv
with
his
family
he's
here
also
and
and
they're
from
richmond,
but
I
just
want
to
say
I
want
to
highlight.
We
do
have
a
whole
committee
that
we
meet
with
regularly
on
this
bill.
That
includes
not
only
parents
but
also
physicians
audiologists.
J
We
also
have
partners
in
advocacy
with
kentucky
commission
on
the
deaf
and
hard
of
hearing
the
hearing
and
speech
center
in
lexington,
among
many
others,
as
well
as
the
national
cmv
foundation
and
you'll
hear
from
some
of
those.
But
I
want
to
highlight
as
well
right
before
us.
They
testified.
You
know
about
the
safe
sleep
and
and
different
things
like
that.
I
know
when
I
was
pregnant,
I
was
told:
don't
change
the
cat
litter
box
and
don't
eat
deli
meat
and
the
same
thing
with
safe
sleep.
J
One
big
thing
we're
pushing
which
is
in
the
committee
sub
is
education
and
we
need
we.
We
need
to
see
more
of
that
for
our
expectant
mothers,
so
that
they're,
aware
of
cmv,
because
ultimately
our
goal
is
to
see
less
cases
and
then,
of
course
be
able
to
screen
the
ones
where
that
is
an
issue.
And
then
we
do
have
three
people
joining
us
by
zoom.
H
Hi
good
morning,
I
appreciate
the
opportunity
to
talk
to
you
this
morning.
My
name
is
dr
laura
stadler,
I'm
from
lexington
kentucky,
I'm
a
pediatric
infectious
disease
doctor
and
I
have
worked
towards
getting
universal
screening
in
our
nicu
and
a
failed
hearing
initiative
in
our
nursery
and
another
local
hospital.
I
also
treat
infants
with
congenital
cmv
with
an
antiviral
to
decrease
the
progression
of
hearing
loss
and
I'm
happy
to
talk
more
later
I'll.
Let
everyone
else
introduce.
K
I'm
a
previous
president
of
the
kentucky
chapter
of
the
aap,
the
american
academy
of
pediatrics,
and
I
was
the
state
champion
for
the
eddie
program
from
its
inception
to
approximately
five
years
ago.
Eddie
stands
for
early
hearing
detection
and
intervention,
and
I
just
want
to
state
that
my
statements
today
represent
my
own
opinion
and
not
those
of
norton
healthcare
or
the
university
of
louisville.
Thank
you.
L
Hi,
my
name
is
amanda
devereaux
and
I
am
the
program
director
at
the
national
cmv
foundation,
we're
here
just
to
provide
our
support
for
the
bill,
I'm
also
the
parent
of
a
child
who
was
born
with
congenital
cmv,
not
in
kentucky
but
important
to
note
that
she
was
born
looking
completely
typical,
even
though
she
is
significantly
disabled
by
the
virus.
So
we're
happy
to
provide
support
and
can
can
provide
input.
There's
a
lot
of
activity
happening
across
the
country,
different
types
of
legislation
getting
passed,
so
we're
happy
to
provide
information
on
that.
C
C
So
the
legislation
real
briefly
provides
two
parts:
one's
an
educational
tool,
piece
of
where
the
department
for
public
health
would
make
available
on
their
website
providing
educational
resources
every
as
regards
to
the
incidences
of
cmv,
and
that
information
could
talk
about
the
transmission
and
how
that
can
be
before
and
during
pregnancy,
as
well
as
birth
defects
that
were
caused
by
cmv,
the
methods
of
diagnosis
of
cmv
and
any
other
preventative
measures
that
can
be
made
available.
C
It
also
gets
into
the
screening
portion
of
the
bill
if
you'll
look
in
terms
of
the
legislation,
that's
before
you
that
every
infant
in
in
this
state
who
is
given
an
auditory
screening
test,
as
is
described
in
ksr216.2970,
and
if
they
fail
those
initial
two
screenings
or
have
either
risk
factors
associated
with
cmv
that
they
shall
be
tested
for
cmv
no
later
than
21
days
after
the
date
of
birth
by
the
health
facility
or
the
physician.
C
That's
providing
the
services
to
the
infant
unless
the
parents
are
guarding
to
the
infant
or
out
of
testing,
so
two
components
there.
I
appreciate
the
compromise.
I
appreciate
the
work
that
was
done
on
this
and
I'll
open
up
if
miss
roofe.
For
mr
ball
want
to
provide
any
other
comments
or
any
questions
that
members
may
have.
A
Thank
you
senator.
I
appreciate
that.
I
appreciate
you
working
with
me
on
this.
This
is
something
we
I
know
we
talked
about.
I
think
when
the
original
bill
was
filed,
it
was
kind
of
a
desire
to
do
a
lot
of
the
testing
with
genetic
testing,
which
is
an
acquired
disorder.
Obviously,
and
I
know
we
took
a
look
at
what
other
states
have
done
in
this
regard
and
try
to
find
the
best
options
for
that
we've
got
some
feedback
from
you
know
a
lot
of
the
stakeholders.
A
I
pre
appreciate
dr
stadler,
dr
stewart
being
on
the
line
as
well.
I've
reached
out
to
the
american
college
of
ob
gyn
on
this
issue.
They,
like
the
language
in
this
statute,
that's
proposed,
and
perhaps
dr
stadler
you're,
the
pediatric
infectious
disease
doctor.
If
you
could
comment
really
quickly,
I
know
I've
reached
out
to
some
pediatric
physicians,
who
feel
that
there's
still
a
little
bit
of
an
unknown
on
getting
a
standardized
treatment
for
kids.
H
Yes,
so
I
do
not
see
many
false
positives.
The
test
screening
have
high
likelihoods
probability
of
likelihood
of
a
true
diagnosis,
so
the
pcrs,
which
many
people
use
nationally
across
the
country,
approximate
98,
99
percent
accuracy
old
school.
We
used
to
use
urine
culture,
I've
been
out
of
medical
school
for
21
years,
and
that
was
the
gold
standard.
So
the
current
standard
of
care
from
american
academy
of
pediatric
sexual
infectious
disease
is
to
identify
babies
in
the
first
three
weeks
of
life
such
that
we
can
start
an
antiviral.
H
A
publication
by
dr
david
kimberlin
who's.
Currently
at
uab
in
birmingham
was
published
in
2003
with
iv
ganz
cycle
gear.
Many
of
us
were
using
oral
valgand
cyclovir,
which
is
kinder
and
gentler
twice
a
day.
Babies
can
go
home
with
their
family,
the
publication
for
that
is
2015
england
journal
of
medicine,
but
many
of
us
were
using
it
in
2013
because
we
knew
preliminary
data,
and
so
the
current
standard
of
care
is
to
start
an
antiviral.
H
If
the
baby
is
unable
to
take
oral
medication,
they
start
with
iv,
perhaps
in
an
icu
setting,
and
they
transition
to
outpatient
management
with
an
oral
antiviral
that
publication
indicated
not
just
six
weeks,
but
actually
these
babies
are
on
six
months
of
oral
antiviral
therapy.
It's
twice
a
day.
The
babies
have
laboratory
monitoring
while
they're
on
that
therapy.
H
The
the
medications
kind
of
claim
to
fame
is
to
decrease
progression
of
hearing
loss.
So
we
know
cmv
is
the
most
common
congenital
viral
infection
in
babies,
it's
the
most
common
preventable
cause
of
infant
disability
and
so
identifying
these
babies
there's
a
lot
of
good
reasons
to
do
that
to
help
the
baby
and
parent
family
get
in
for
early
intervention
services,
so
their
speech
and
language
development
can
be
maximized
to
get
them
in
with
audiology
every
three
months.
H
They'll
have
a
bear
or
audiology
screening
to
maximize
if
they
do
have
loss
either.
Hearing
aids
are
eventually
cochlear
implant
and
I
think
it's
real
important
to
identify
these
babies
early
such
that
families
are
aware
of
the
diagnosis
and
we
can.
We
can
start
to
move
forward
with
maximizing
their
neural
development.
H
So
a
lot
of
what
I
do
is
obviously
the
screening
programs,
but
then
our
practice
starts
antiviral
therapy
if
they're
candidates,
and
also
just
maximize
the
care
and
support
for
that
patient
and
family,
it's
a
multi-disciplinary
effort
and
so
audiology
ent,
the
general
primary
care
pediatrician
is
instrumental
in
that,
and
there
are
some
other
states.
Who've
provided
data,
utah
being
one
of
them,
that
by
identifying
these
babies
early,
that
it
reduces
the
newborns
who
are
lost
to
follow-up
and
so
identifying
them
giving
them
a
diagnosis
such
that
parents
can
learn
more
about
their
baby.
H
We
we
see
better
outcomes
for
the
baby
and
for
family
and
we're
really
interested
and
appreciative
of
the
education
component.
The
other
thing
I
would
say
from
personal
experience
is
often
when
I
meet
a
family.
One
of
the
first
things
I
hear
is
that
the
mother
has
largely
unaware
of
cmv,
has
never
heard
of
this
diagnosis.
H
A
Thank
you
doctor.
I
appreciate
that.
Do
you
recommend
I
mean
for
the
screening
if
a
child
has
positive
just
for
my
own
education,
a
pcr
test
initially
or
a
urine
test,
I
know
there's
saliva
urine.
I've
heard
I've
seen
all
those,
so
I'm
just
curious
what
the
initial
screening
for,
if
I'm,
in
a
nursery
taking
care
of
a
baby,
they
fail
their
algo
screening.
Do
I
get
a
urine
or
do
I
go
ahead
and
go
get
a
pcr
right
out
of
the
gate.
H
There's
a
jama
publication
early
on
that
the
dried
la
spot
or
the
blood
test
or
blood
pcr
will
only
pick
up
those
babies
who
are
severely
symptomatic
or
have
high
viral
lobes,
and
so
at
our
institution
we
chose
to
use
urine
largely
because
of
cost.
H
So
when
I
set
up
the
screening
program
here
in
lexington,
we
looked
at
cost
of
urine
culture,
urine,
pcr
and
saliva,
and
we
also
looked
at
turnaround
time
anticipated
turnaround
time.
So
the
cost
to
the
patient
is
actually
lowest
with
the
urine
pcr.
The
cost
of
the
institution
is
lower
with
a
culture,
so
it
just
these
little
nuances
that
we
have
and
then
for
us
at
our
institution,
the
saliva
pcr.
H
There
are
some
things
that
make
it
a
little
cumbersome.
So
in
the
nicu
patient
population,
it's
recommended
that
no
baby
have
what's
called
an
ng,
so
a
tube
from
the
nasogastric
location
or
babies
who
reflux
or
babies,
who
have
recently
had
either
donor
breast
milk
or
mom's
breast
milk.
If
there's
any
milk
contained
in
the
mouth
within
an
hour,
it's
possible
if
mom
has
cmv
in
her
breast
milk
that
she's
either
reactivated
or
has
present
that
saliva
specimen
may
be.
That
may
be
a
false,
positive,
but
other
study.
H
You
know
other
diagnostics
that
are
submitted
or
not
ought
to
be.
So
at
our
institution
we
tried
the
saliva
and,
in
our
particular
institution
the
laboratory
with
which
our
organized
organization
has
contracted
with.
We
had
a
turnaround
time
of
14
days,
and
we
found
that
to
be
largely
unacceptable
because
we're
trying
to
make
a
diagnosis
within
the
first
three
weeks
of
life.
So
there
there
are
several
accepted
laboratory
diagnostics
according
to
national
authorities,
but
at
our
institution
we
use
a
urine
cmv
pcr.
B
Thank
you,
and
this
is
going
to
be
sort
of
a
trivial
question,
but
I'm
noticing
that
we're,
including
cmv
in
the
list
of
of
herod
inheritable
disorders.
Do
we
not
keep
a
separate
list
of
congenital
in
utero
infectious
disorders
in
this
state?
I
mean
I
don't
understand
why
we're
putting
cmv
in
the
same
category
as
these.
A
I
Because
this
is
also
educational
and
because
maybe
not
everybody
tuning
in
today
heard
this
in
the
interim.
Could
I
hear
from
the
mom
or
from
one
of
the
docs
to
tell
how
this
is
contracted
and
do
we
know
how
it's
contracted
just
just
some,
just
a
little
bit
of
the
background
on
cnb?
I
Maybe
would
you
prefer
one
of
the
docs
to
talk
about
it
and
maybe
they
defer
to
them
sure
I
can
start
cmv
is
described
to
me
it's
much
like
strep,
throat
or
or
any
other
infectious
disease.
However,
cmv
is
one
of
the
the
viruses
that
actually
can
transfer
through
placenta
walls.
So
in
my
case
this
is
not
the
same
for
everyone,
but
in
my
case
I
was
not
sick.
I
However,
I
had
to
have
contacted
that
sometime
during
my
pregnancy
and
my
infant
contacted
that
we
had
a
perfectly
normal
pregnancy.
No
complications
at
all
was
born
in
a
local
hometown
hospital,
but
she
did
have
to
be
life
flighted
out
because
she
was
very
sick
at
birth.
So
we
had
no
prior
warning
to
this
and
no
prior
knowledge
of
cmv.
I
It
took
three
days
before
she
was
actually
diagnosed
in
the
nicu
with
congenital
cmv,
and
at
that
time
they
did
try
to
look
back
at
my
history
to
see
if
they
could
identify
when
she
became
sick,
but
I
had
no
sickness,
so
there
was
no
identification
there,
so
her
being
very
ill
at
birth.
Was
that
all
related
to
the
cmv?
Oh
absolutely!
Yes,
she
had
enlarged
liver,
enlarged
spleen.
Her
blood
platelets
had
bottomed
out.
She
was
down
to
like
20
on
her
blood
platelets.
I
She
was
covered
in
petechiae
that
they
all
caused
also
called
the
blueberry
rash.
She
was
very
sick,
yes,
so,
and
all
of
that
was
related
to
cmcc.
Thank
you.
J
So
and
it's
usually
and
some
of
the
preventive
measures
that
we
advocate
for
are
especially
with
young
mothers
who
have
toddlers
at
home
working
in
daycare
settings
so
don't
put
a
pacifier
in
your
mouth,
sharing
saliva
things
like
that,
so
those
are
just
some
preventive
measures
that
can
be
used
that
you
know
when
you
have
a
little
one,
you
don't
don't
kiss
on
the
mouth.
You
know
with
a
toddler
which
is
not
always
easy,
but
those
are
some
of
the
things
dr
stadler
amanda.
K
Sorry,
yes,
so
the
mother
can
get
a
primary
infection
where
it's
an
almost
like,
almost
like
a
flu-like
illness.
So
but
some
of
the
obstetrical
health
care
providers
aren't
even
aware
of
this
and
may
not
test
for
cmv,
but
more
commonly,
as
sarah
was
talking
about,
the
mother
may
acquire
with
changing
diapers
and
a
daycare
that
type
thing
and
not
using
good
soap.
K
Soap
and
water
good
hand,
hygiene
and
often
it's
transmitted
like
that.
But
again
to
emphasize
what
was
said
is
that
you
don't
kiss
a
baby
in
the
mouth.
You
don't
share
parasites,
you
don't
put
the
pacifier
in
your
mouth
and
then
give
it
to
the
baby
to
acquire
it,
but
during
pregnancy,
obviously
a
a
a
flu.
A
viral
illness
could
obviously
be
cmv,
but
it
as
is
talked
about
there.
We
don't
always
see
that.
A
B
Senator
rocky
adams,
senator
berg
I
and
I
would
like
to
say
that
I
really
really
appreciate
the
work.
That's
been
done
on
this
bill
since
the
last
time
I
heard
it.
I
think
it
is
strong
at
this
point,
and
I
appreciate
that.
Thank
you.
A
Aye,
the
matter
passes
with
a
vote
of
11-0.
Thank
you
all
so
much
for
your
advocacy.
This
is
the
kind
of
work
that
pays
off.
I
know
sometimes
it
feels
slow,
but
there
is
a
process
to
this
senator
wise.
Thank
you
for
your
work
on
this
as
well
be
reported
favorably
to
the
senate
floor.
Thank
you.
All.
J
And
I
just
want
to
say
thank
you
one
last
time
this
saturday
would
have
been
bella's
fifth
birthday,
so
thank
you.
I
can
think
of
no
greater
gift
for
her
and
her
family.
Thank
you.
A
Thank
you,
sir
appreciate
it
all
right.
The
last
item
on
the
agenda.
We
have
is
senate
joint
resolution
72.
This
is
a
joint
resolution
directing
the
cabinet
for
health
and
family
services
to
apply
for
a
medicaid
waiver
for
individuals
with
severe
mental
illness
and
declaring
an
emergency.
I'm
the
sponsor,
I'm
going
to
stay
right
here.
I
think
mr
steve
shannon
is
coming
to
the
table
also
to
be
able
to
answer
any
questions.
C
A
I'll
be
very
brief
in
my
remarks,
we
had
a
a
lot
of
good
work
done
this
interim
on
the
severe
mental
illness
task
force
that
was
chaired
by
senator
kerr
and
by
representative
bentley.
We
heard
a
lot
of
testimony
and
there
are
a
lot
of
findings
and
for
those
of
you
who
maybe
didn't
tune
in,
I
know
that
those
findings
and
recommendations
for
the
task
force
were
issued
on
november.
The
16th
and
I
do
have
a
copy
of
those.
A
The
first
recommendation
that
was
achieved
by
that
that
task
force
was
to
do.
This
very
thing
was
direct
the
cabinet
for
health
and
family
services.
If
you
look
at
the
recommendations,
the
wording
again
in
this
is
almost
identical,
and
so
this
is
trying
to
comply
with
those
recommendations,
and
I
think
there
was
a
lot
of
agreement
on
trying
to
create
a
waiver
and
to
provide
some
direction
for
the
cabinet
with
that.
If
you
would
like
to
introduce
yourselves
to
the
record
and
then
begin
any
testimony
regarding
this.
G
G
I
started
when
I
was
10.,
so
I'm
still
real
young
and
I
think
steve
shannon
and
I
have
been
trying
to
get
an
smi
waiver
for
probably
20
of
those
years
so
to
have
the
task
force,
appointed
and
actually
four
of
your
committee
members
served
on
that
task
force
and
we're
so
grateful
to
senator
kerr
for
co-chairing
that
with
representative
bentley.
G
One
of
the
things
that
we
heard
over
those
five
to
six
months
was
so
much
testimony
about
what
we
call
the
revolving
door.
We
have
people
with
a
diagnosis
of
severe
mental
illness
and
then
for
whatever
reason,
typically
because
they
fail
to
continue
to
take
their
needed
medications,
they
fall
into
a
downward
spiral
and
they
end
up
in
trouble
with
the
law.
They
end
up
under
a
202,
a
involuntary
commitment
they're
in
and
out
of
the
hospital
they
often
end
up
homeless.
G
So
we
have
tried
for
a
lot
of
years
to
do
something
about
the
revolving
door
and,
as
senator
rocky
adams
knows,
we
passed
tim's
law
in
2017
and
we
still
are
fine-tuning
that
you
all
will
see
some
bills
from
representative
fleming
to
fine-tune
tim's
law.
But
one
of
the
things
that
we
have
come
back
to
over
and
over
and
over
again
is
the
need
for
a
24
7
residential
supported
option
for
our
people
with
severe
mental
illness.
G
They
are
people
that
are
prone
to
delusions
and
hallucinations,
usually
diagnosed
in
early
adulthood
and
then
with
ongoing
diagnoses.
So
we're
talking
about
people
with
schizophrenia,
people
with
schizoaffective
disorder,
bipolar
disorder
and
so
forth.
So
why
have
I
have
this
joint
resolution?
G
G
We
want
to
point
out
that
adults
with
severe
mental
illness
are
the
only
adult
population
with
disabilities
in
kentucky
that
do
not
have
their
own
specialized
waiver,
and
those
of
you,
I
know,
are
familiar
with
waivers.
They
allow
you
to
provide
services
that
would
not
otherwise
be
available
through
traditional
medicaid,
so
we
wanted
to
emphasize
the
24
7
residential
option.
G
This
also
includes
a
supported
employment
option
and
we
heard
some
excellent
testimony
during
the
task
force
about
how
important
to
people
with
a
severe
mental
illness
diagnosis
it
is
to
have
meaningful
work
and
so
supported.
Employment
would
allow
them
to
get
ready
for
work
in
the
marketplace.
G
These
are
not
specialized
work
programs,
but
also
to
have
a
job
coach
and
to
work
with
employers
who
would
be
aware
of
some
of
the
limitations
that
people
with
severe
mental
illness
might
have.
And
finally,
we
really
wanted
to
make
sure
that
this
waiver
was
about
people
with
severe
mental
illness.
Only
there
are
lots
of
populations
in
kentucky,
as
you
know,
from
the
work
that
was
done
in
the
1915
c
hcb
waivers
that
include
people
with
developmental
intellectual
disabilities.
G
We
now
have
a
waiver,
that's
in
front
of
cms,
for
people
with
substance
use
disorders.
We
have
acquired
brain
injury,
but
we
don't
want
to
combine
this
with
any
other
population,
there's
a
sufficient
number
of
folks
with
severe
mental
illness,
and
they
need
this
waiver
to
be
focused
entirely
on
them.
G
So
we're
asking
for
the
passage
of
this
resolution
to
make
sure
that
the
cabinet
understands
the
intent
of
the
legislature
that
this
be
an
smi
waiver
that
includes
a
24,
7
residential
option
and
the
supported
employment,
and
I'm
going
to
turn
it
over
to
my
colleague,
steve,
shannon,
who
you
all
know
who's
great
with
the
numbers,
and
he
can
talk
about
the
costs
and
the
cost
offsets
and
I'm
happy
to
answer
any
questions.
Thank
you.
E
Again,
I'm
steve
shannon
I'm
with
carp
the
association
of
criminal
health,
centers
and
really,
as
dr
schuster
said,
I'm
going
to
talk
about
the
cost.
This
is
not
going
to
be
free.
It's
it's!
It's
not
a
secret!
We're!
Looking
at
the
biannual
budget,
the
first
year
there's
going
to
be
planning
by
the
cabinet.
No
people
served
that's
kind
of
typical.
It
takes
a
while
to
get
a
waiver
approved
second
year.
My
model,
100
people,
served
look
at
the
resolution.
It
says
over
a
hundred
thousand
people
who
are
seriously
mentally
ill.
E
That's
not
the
intent
of
this
resolution
to
provide
residential
services
for
a
hundred
thousand
people.
You
start
small.
You
figure
out
how
to
do
it.
So
what
I
did
this
is
based
on
an
scl
expansion,
sportsman
living
expansion
going
back
to
2000.
I
think
there's
not
going
to
be
a
hundred
people
to
be
served
july,
one
of
the
second
year
of
the
biennium,
which
would
be
fiscal
year,
24
july
1
of
23..
E
It's
going
to
phase
it
in
okay,
so,
instead
of
having
100
people
for
12
months,
which
would
be
1200
months,
this
would
be
eight
a
month
and
probably
slower
than
that
to
figure
out
what
we're
doing,
how
to
do
it.
So
maybe
664
months
is
number
I
come
up
with,
but
my
estimation
based
off
the
scl
rate,
because
that's
a
residential
option
as
well
and
again
not
all
100
people
are
going
to
take
a
residential
option,
but
many
people
will
because
it's
necessary.
E
I
can
come
up
with
a
cost
of
about
4.6
million
dollars
in
the
second
year
of
the
biennium
and
that's
under
the
assumption
of
phasing
it
in,
and
everyone
taking
a
residential
option
right
now,
there's
an
enhanced
match
rate
21.79
on
them.
That
makes
it
our
cost.
Kentucky's
cost
960
000
30
70
is
about
1.3
million
of
kentucky
state
general
fund
dollars.
That's
the
cost,
I'm
not
going
to
deny
that
this
is
not
going
to
be
free.
E
It's
going
to
make
budget
neutrality
really
hard
to
prove
and
I've
had
this
conversation
meredith
many
times,
where's
the
savings.
I'm
going
to
be
honest
about
that.
There
may
be
cost
offsets,
there
may
not
be
savings
and
I
say:
cost
offsets
less.
Er
visits
not
going
to
spend
money
there.
The
er
is
not
going
to
get
smaller,
but
they're
not
going
to
spend
money.
There's
not
going
to
be
people
in
the
er
who
don't
need
to
be
at
the
er
they're
going
to
be
supervised,
they're
going
to
have
case
management.
E
They're
going
to
be
very
you
know,
so
they're
not
going
to
go
to
the
er
necessarily.
I
think
it
could
be
50
visits
a
year
for
100
people.
That's
not
unrealistic
for
folks
who
have
nowhere
to
go
nowhere
to
go.
They
go
to
the
er
that
can
save
87
000
law
enforcement
involvement,
whether
it's
a
202-a,
involuntary
commitment
or
just
a
disturbance
in
the
community.
E
As
you
know,
senator
carroll,
it's
unlikely
one
cruiser
shows
up
with
a
police
officer
that
happens,
one
or
two
or
three
cruisers
may
show
up
may
not
ever
enter
a
psychiatric
hospital,
but
it's
still
using
that
valuable
law
enforcement
resource
to
address
a
problem.
A
residential
option
can
prevent
for
some
people.
E
That's
a
good
use.
Ems
quite
often
shows
up
just
because
it's
a
call
911
call
those
folks
won't
be
going.
I
think
there
could
be
50
episodes
a
year
with
law
enforcement
people,
I've
known
who
are
on
the
streets
who
are
not
in
residential
options,
homeless,
shelters
who
are
severely
mentally
ill,
have
a
lot
of
regular
involvement
with
law
enforcement
and
ems
a
lot
I
had
one
guy,
my
porch
one
day.
Ems
showed
up
because
we
called
because
he
was
threatening
suicide,
and
I
can
remember
clear
as
day
the
ems
asked
him.
E
Where
do
you
want
to
go?
He
said.
Oh
it's
thursday,
st
joe
says
chicken
I
like
to
go
to
saint
joe's.
I
mean
I
mean
he
knew
the
menu.
You
know.
That's!
That's
not
a
good
use
of
ems
time,
huge
waste
of
money
for
remiss
time
residential
option
prevents
that
we
have
behavioral
health
crisis
response,
another
twenty
eight
thousand
dollars,
fifty
thousand
dollars
on
police.
Fifty
thousand
on
the
e
e
e
sorry,
ems,
involuntary
commitments.
202As,
we
have
staff
all
mental
health,
centers
have
staffed
24
7
to
do
an
evaluation
district
judge
times
occupied.
E
E
Also
a
lot
of
folks
who
get
admitted
to
a
hospital
under
involuntary
commitment,
stay
longer,
say
another
10
days
or
so.
Those
are
all
offsets
that
we're
not
going
to
incur.
I
can
get
to
665
000,
just
with
that
list.
I
don't
know
if
housing,
I'm
not
homeless,
shelters,
because
I
couldn't
quantify
that,
but
again
senator
meredith,
I'm
speaking
to
you,
because
we
had
this
conversation,
these
aren't
dollars
that
will
be
freed
up,
but
they
are
dollars
that
can
be
spent
more
effectively
and
used
more
prudently.
E
A
Thank
you
very
much
and
you
don't
even
include
I've
talked
about
long-term
care
in
nursing
homes
and
that's
an
expensive.
You
didn't
include
that
in
the
list.
No.
A
F
F
I
suspect
that
the
savings
will
be
much
more
dramatic
than
what
you've
identified,
but
you've
done
a
yeoman's
job.
I
appreciate
that
one
thing
that
I
would
still
like
to
have
some
kind
of
measurement
for,
and
I
mean
I'm
fully
supportive
of
this
resolution
is
10
years
from
now.
How
do
we
know?
We've
been
successful.
F
For
for
resources,
how
can
we
assure
the
the
public
that
we've
been
successful?
What
we're
trying
to
achieve
here?
I.
E
Think
it's
the
number
of
people
and
and
the
smi
population
is
different
than
other
wafer
populations.
They
can
be
in
a
residential
setting
for
two
years
and
do
well
become
well
stabilized.
They
could
move
out
into
their
own
apartment.
They
could
get
a
job
30
40
hours
a
week
right.
I've
known
people
who
have
had
that
support
and
we
heard
it
from
judge
burke
was
it
last
week
where
she
saw
a
mom
in
the
grocery
store
whose
son
went
through
her
court.
E
Mental
health
court
under
tim's
law
he's
now
not
in
trouble
with
the
law
he's
doing
well.
Those
are
individual
measures
that
are
real
stories
right,
senator
adams,
real
stuff.
That's
one
way
to
look
at
it.
The
number
of
people
who've
gone
from
homelessness
law
enforcement
involvement
to
their
own
apartment.
G
I
think
also
senator
meredith
that
we
will
see
a
reduction
in
the
number
of
involuntary
commitments,
those
202
a's,
and
I
think
that
our
agencies
that
presented
during
the
task
force,
I'm
thinking
of
wellspring
and
louisville
and
new
beginnings
in
lexington
I'll-
probably
have
that
those
numbers
and
we
can
get
those
numbers
from
you.
I
know
that
programs
day
programs
even
like
bridgehaven,
have
tracked
law
enforcement
interactions
and
hospitalizations
and
have
demonstrated
considerable
reductions
when
you
have
ongoing
therapeutic
services.
E
E
F
E
F
And
I
think
that's
one
thing:
I'd
ask
people
this
committee
and
those
of
us
who
serve
on
appropriations
or
revenue
is:
let's
take
this
leap
of
faith
and
a
conversation
with
both
senator
carroll
and
senator
adams
this
morning
again
about
this
subject
about
we're
not
measuring
the
cost
of
doing
nothing,
and
this
truly
is
a
tragic
situation.
It's
a
percentage
of
our
population
that
has
been
ignored
overlooked
for
so
many
years,
and
it
truly
is
tragic.
F
A
A
Aye,
the
matter
passes
the
hero.
Thank
you
all
for
your
work.
I
commend
the
members
of
the
task
force
for
their
work,
because
this
is
a
direct
product
of
that
labor.
It's
very
rare.
When
we
have
a
committee
meeting
where
every
bill
that's
presented,
passes
unanimously,
so
very
good
work
today.
Any
other
questions
before
this
committee.