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A
Got
some
good
news
this
morning,
Bryce
ambergy's,
son
Luke,
is
out
of
the
hospital
I
believe
and
staying
at
the
Ronald
McDonald
house
with
his
parents
in
Cincinnati,
so
our
prayers
have
been
answered.
I
want
to
thank
the
committee
Bryce's
kind
of
the
well.
A
He
is
the
head
of
the
committee
and
he's
been
gone
and
we're
glad
that
he
has
gone
because
he
has
to
take
care
of
his
son,
but
the
committee
staff
has
had
to
fill
in
and
do
double
time,
and
we
certainly
want
to
thank
them
for
doing
that
and
we're
thankful
that
our
prayers
for
Luke
have
been
answered.
Do
any
members
have
any
introductions
they
would
like
to
make.
C
D
A
We
do
have
a
corpsman
or
duly
constituted
to
do
business.
We
are
going
to
go
out
of
order
on
the
agenda
and
take
a
house
bill,
62
first,
because
I
don't
anticipate
that
taking
very
long
Mr
Speaker,
it's
good
to
have
you
here,
introduce
yourself
for
the
record.
I
know.
We've
heard
this
during
the
interim
and
I
do
appreciate
that
so
I
think
it's
been
well
vetted
and
to
introduce
yourself
for
the
record
and
proceed
with
your
testimony.
Well,.
E
Thank
you
Mr
chairman
and
members
of
the
committee.
My
name
is
David
Mead
I'm,
the
speaker
Pro
tem
of
the
house,
and
we
have
the
Kentucky
Realtors
president
Elizabeth
Monarch
with
us
as
as
well
this
morning
at
the
table.
What
this
is
House
Bill
62
is
what
we
call
the
wholesaling
bill.
This
bill
simply
is
taking
wholesalers
and
saying,
if
you're,
going
to
advertise
a
property
that
you
don't
own,
but
you
you
have
put
down
a
contract
on
something
like
that.
E
Then
you
are
going
to
be
licensed
as
a
real
estate
agent,
and
the
reason
for
that
is
because
now
I'm
not
going
to
say
that
all
wholesalers
are
doing
anything
incorrectly,
some
do
this
properly,
but
many
Don
don't
and
what
what
they
do
is,
for
example,
I
had
an
instance
here,
a
while
back
where
these
wholesalers
were
contacting.
Folks,
who
don't
know
the
market
primarily
older
folks
in
our
communities,
talking
them
about
their
properties
and
a
lot
of
times.
E
They'll
use
PVA
values,
because
we
know
they're
less
a
lot
of
times
than
what
the
actual
value
of
property
is
says.
Hey
PVA
value
says
your
property's
worth.
Fifty
thousand
I'll
give
you
60
for
it,
knowing
it's
worth
a
hundred
and
sixty
thousand
or
whatever
it
may
be,
and
they
get
a
contract
on
that
property.
They
never
intend
to
take
possession
of
that
property.
They
then
try
to
sell
the
property
to
somebody
else
or
this
contract
to
someone
else
and
try
to
Bank
off
of
that.
E
Equity
that
that
person
has
in
that
home
it
leaves
them
in
a
bad
place.
It
also
loses
that
Equity
that
they
had,
and
it's
basically
just
a
predatory
practice
to
take
advantage
of
those
who
don't
know
the
market
and
so
by
making
them
licensed
real
estate
agents
they're
doing
the
same
job
as
a
real
estate
agency
agent.
But
now
this
puts
them
under
the
fiduciary
duty
that
an
agent
has
they
have
to
give
their
seller
the
absolute
best
service.
E
They
have
to
try
to
get
the
most
money
for
it
and
treat
them
fairly
so
that
that's
how
we're
trying
to
solve
that
problem.
This
again
does
not
touch
for
sale
by
owners.
It
does
not
touch
it
if
you
are
flipping
properties,
if
you're
taking
possession
of
those
properties
and
flipping
them
for
commercial
purposes.
It
is
simply
if
you
are
trying
to
get
those
contracts
so
that
you
can
advertise
that
property
and
then
try
to
make
money
off
of
that
equity
in
that
person's
property.
But
that's
basically
what.
A
The
bill
does,
thank
you.
Would
you
guess
like
to
introduce
yourself
for
the
record
and
make
a
few
comments.
F
On
behalf
of
the
Kentucky
Realtors,
we
are
honored
here
to
present
House
Bill
62
to
you
all
as
president
of
the
Kentucky
Realtors
I
am
here
to
represent
over
13
000
kentuckians,
who
are
involved
in
all
aspects
of
real
estate,
including
residential
commercial,
real
estate
brokers,
sales
associates
developers,
Builders
and
property
managers.
Kentucky
Realtors
support,
House
Bill
62
because
it
protects
the
consumer
and
we
respectfully
request
your
support.
Today.
The
proposed
legislation
would
actually
require,
as.
A
A
Had
a
motion
Senator
there
is
there
a
second
Senate
second
from
Senator
nemes,
well
further
discussion,
I'd
like
to
ask:
is
there
anyone
here
that
wants
to
speak
against
this
bill.
A
D
Nemus,
yes,
Miss
Monarch
I've
been
to
your
auctions
before.
Would
this
prohibit
me
from
advertising
the
house
that
you're
going
to
auction
so
I
know
what
I
might
want
to
bid
for.
D
Well,
the
particular
property
it
would
be
limited,
but
I
still
might
want
to
go
through
emails,
or
my
contacts
and
per
se
advertise
it
to
see
what
someone
might
pay
for
it.
And
that
way,
when
I
go
to
your
auction,
I
have
an
idea
of
what
I
might
want
to
bid
well.
F
Sir,
we
do
cooperate
with
real
estate
agents,
so
if
you
would
like
to
send
that
to
a
potential
client
that
you're
representing,
we
do
work
with
you
in
terms
of
an
auction,
but
if
you
were
to
come
and
make
an
offer
on
my
property
and
my
seller
was
to
accept
it
and
then
you
want
to
go
out
and
advertise
that
without
a
real
estate
license
to
the
public,
I
would
say
this
is.
This
is
exactly
what
we're
trying
to
stop.
E
Thank
you,
I
think.
If
I
could
add
to
that,
I
think
I
understand
what
you're
asking
Senator,
nemus
and
I
and
I
I
am
involved
in
flipping
properties
as
well
myself
and
so
you're
you're.
Talking
about
making
those
personal
contacts
to
someone
to
say
hey.
If
I
were
to
buy
this
property,
would
you
be?
What
would
you
be
willing
to
pay
for
it
and
I?
Don't
think
that
that
would
be
covered
under
this?
This
is
that's
an
individual
contact
and
you're
not
actually
advertising
the
property.
H
Hal
explain
my
vote,
vote
and
explain,
vote
I
and
thank
you
for
bringing
this.
This
has
been
an
issue
in
my
area.
Quite
a
bit
and
people
don't
understand
what
true
value
is
anymore
in
some
of
our
properties,
even
without
the
recent
run
up
in
the
real
estate
market
and
it's
something
that
we
needed
to
get
into
place
to
protect
all
parties
and
I
just
appreciate
your
time
on.
A
A
A
The
next
item
on
the
agenda
is
Senate
bill.
67.,
Senate,
Bill
67
was
heard
during
the
interim.
It
came
through
this
committee
and
was
passed
out
and
then
it
was
sent
back
to
this
committee
for
today.
So
that's
where
we
are
today.
It's
an
act
relating
to
freestanding
birthing
centers.
The
sponsor
is
Shelley
Senator
Shelley
funky
frohmeyer
welcome,
Senator,
it's
great
to
have
a
Northern
Kentucky
and
with
us
today,
and
that
you're
no
stranger
to
this
committee
I
believe
you
have
a
sub.
Don't
you?
Yes,.
A
So
at
this
time,
I'll
entertain
a
motion
to
adopt
the
sub,
who
made
that
doc
I
believe
was
how
how,
in
the
second
about
Senator
Adams,
is
that
correct,
yeah,
okay
motion
been
made
by
a
house
second
or
by
Senator
Adams?
All
those
in
favor
use
the
voting
sign
of
I
anyone
opposed
like
sign.
We
have
adopted
the
sub,
let
the
record
reflect
Senator,
introduce
yourself
for
the
record
and
proceed
with
your
testimony
and
I
think
we
probably
want
an
emphasis
on
what
are
changed
in
the
set
great.
I
Thank
you
Senator
schickel,
and
thank
you
for
allowing
us
to
come
back
and
visit
with
you
today
and
I.
Also
Shelly
funky
fro-meier,
Senate,
District,
24,
Campbell,
Kenton,
Boone
and
Bracken
County.
A
I
I
didn't
mean
to
interrupt
you
Senator,
but
I
feel
compelled
to
announce
this
I
am
going
to
start
the
clock.
There's
gonna
be
fifth,
we're
gonna
shoot
for
15
minutes,
okay,
and
that
includes
questions
because
I
have
a
long
list
of
people
here
that
want
to
talk,
and
then
you
will
have
a
chance
to
come
back
and
and
we'll
go
back
and
forth,
but
I
want
to
respect
everyone's
time.
So
I'm
starting
the
clock
now
go
ahead.
Thank.
I
You
and
Mary
Catherine
delaughter
is
with
me
as
well
the
director
of
the
birthing
Coalition
and
she
won't
intend
to
speak
unless
you've
got
some
specific
questions.
We
also
have
the
Educators
from
Frontier
nursing
University
and
we
had
a
guest
appearance
by
a
baby
as
well.
So
we've
got
a
lot
of
good
stuff
for
you.
So
what
you'll
find
in
the
committee
said,
we
really
tried
to
address
some
of
the
concerns
from
our
hospitals.
I
So
you'll
see
that
this
is
an
even
more
robust
Bill
than
what
you
had
the
opportunity
to
view
with
us
a
couple
weeks
back,
but
to
be
very
clear,
freestanding
birthing
centers
are
authorized
in
Kentucky
today
in
2017
there
were
multiple
appeals
and
exhausted
the
financial
resources
of
a
midwife
who's.
No
longer
here
in
Kentucky.
She
could
not
achieve
the
opportunity
to
open
her
birthing
center,
but
she
certainly
tried
so
what
you'll
find
in
the
Senate
Bill
67
is
establishing
a
waiver
of
the
certificate
of
need
in
Section
1
3.
I
We
placed
a
four
bed
limit
requiring
that
if
you
have
four
or
fewer
beds,
you
could
be
waived,
but
if
you
have
five
or
more
you'll
be
expected
to
go
through
the
certificate
of
need
process.
So
that's
an
addition,
since
we
last
prepared
and
brought
this
to
you,
this
truly
is
a
concession
to
the
Kentucky
Hospital
Association.
The
second
key
action
of
this
bill
is
to
modernize
the
statutes,
including
the
cabinet's
responsibility,
to
delineate
requirements
for
medical
malpractice
insurance
for
freestanding
birthing
centers.
So
you'll
also
see
that
on
number
three,
that's
even
on
page
one.
I
Our
point
is
reducing
government
intervention,
we're
we're
pushing
towards
more
free
enterprise,
reducing
the
cost
to
families,
the
cost
to
insurance
companies
and
the
cost
to
the
state
of
Kentucky.
We
want
to
increase
safety
when
Jesus
was
a
kid.
He
had
an
unconventional
birth,
but
more
babies
are
being
born
at
home
than
in
modern
history,
including
my
granddaughter.
My
granddaughter
Charlotte
Anne
freestanding
birthing.
Centers
will
give
women
and
families
a
place
for
prenatal
and
perinatal
mental
health
and
anxiety
attention.
I
It
will
be
much
like
an
outpatient
birthing
experience.
This
bill
is
now
32
Pages.
As
you
see,
it
is
really
truly
to
make
clear
the
responsibilities
of
the
birthing.
Centers
you'll
see
this
in
section
three
and
then
moving
into
section
six
you'll
see
that
the
additional
changes
make
freestanding
birthing
center
staff
require
to
complete
those
Vital
Statistics,
the
documentation
for
birth
certificates
and
paternity
establishment.
I
Section
10
relates
to
the
testing
and
the
information
to
side
Omega
virus
passed
in
late
2022.,
so
section
11,
that's
new.
This
was
not
previously
in
the
bill,
but
it
does
add
free
standing,
birthing
centers
to
the
definition
of
Health
Facilities,
so
I
think
you'll
find
that
we
were
quite
thorough.
We
took
this
to
another
level,
but
recognizing
that
we
want
you
to
address
the
statute,
we
want
the
cabinet
to
address
the
regulations.
We
were
not
trying
to
accomplish
all
that
in
this
bill.
I
To
summarize
8
out
of
50
states
do
not
offer
free
standing
birthing
centers.
Only
eight
Tennessee
has
two
West
Virginia
has
one
Ohio
has
three
Indiana
has
seven
I
believe
if
we're
going
to
achieve
our
Wellness
Revolution
I
really
do
believe
we
got
to
be
accountable
for
ourselves
and
freestanding
birthing.
Centers
are
an
excellent
and
perhaps
safer
alternative
to
home
births.
I
What
I'll
acknowledge,
though,
is
large
studies
show
that
9
out
of
10
women
entering
birthing
centers
achieve
a
vaginal
birth.
This
means
that
that
C-section
rate
is
four
times
lower
than
that
scene
among
low
risk
women
in
Kentucky
right
now,
perinatal
mental
health
during
the
prenatal
and
the
postnatal
is
receiving
a
much
greater
priority.
With
the
Midwifery
model,
practitioners
visit
at
a
longer
length
with
the
mothers
with
the
family.
They
are
focusing
on
physical
mental
nutritional
they're.
Looking
for
the
success
but
they're,
also
looking
for
where
Mom
needs,
Improvement
I
think
that's.
I
Why
you'll
see
that
the
outcomes
are
so
excellent
and
so
strong
with
this
Midwifery
model?
The
the
one
key
item
I
want
to
express
there
is
such
a
significant
rate
of
adoption
for
breastfeeding.
Why
is
that,
when
you
have
the
prolonged
skin
to
skin
contact
that
occurs
for
hours
after
birth,
This,
truly
bonds,
a
family?
This
is
improving
the
mental,
the
emotional.
This
lasts
a
lifetime.
It
is
scientifically
proving
that
breastfeeding
creates
and
sets
up
emotional
and
physical
well-being.
That
is
not
seen
without
it.
I
Certified
nurse
practitioners
advanced
practice,
nurses.
They
are
committed
to
the
care
with
hemorrhaging.
We
have
done
much
work
in
the
Kentucky
legislation
to
allow
them
the
ability
to
prescribe
and
to
carry
these
medications.
So
it
truly
addresses
some
of
those
emergencies
that
the
hospital
Association
is
trying
to
alarm
us
with.
We
are
addressing
this.
I
Our
desire
is
to
remove
the
barriers.
These
are
small
businesses,
I'm
a
small
business
owner
I
admire
that
we
are
trying
to
put
in
place.
These
professionals
are
meeting
a
need.
This
is
a
need.
Women
are
in
demand
of
something
more
affordable,
safer
than
the
home
birth
and
in
a
way
to
maximize
and
optimize
their
health
outcomes.
I
A
D
Yes,
you
say
that
one
in
ten
have
C-sections
at
birthing,
centers
and
that's
higher
at
a
hospital.
Is
that
correct,
and
also
is
that
not
because
most
that
think
they
might
need
or
do
need
a
C-section
would
go
to
hospital
anyway,
so
it
wouldn't
that
be
kind
of
a
stat.
That's
not
really
true
to
true.
J
So
when
we
talk
about
so
the
C-sections
aren't
performed
at
a
birth
center,
but
that
doesn't
mean
that
someone
who
came
into
their
birthing
process
not
planning
a
C-section,
but
at
some
point
it's
determined
that
maybe
they
need
one
or
they
transfer
to
the
hospital
and
then
after
they
transfer
it's
determinants.
They
need
one.
So
those
people
who
transfer
to
the
hospital
and
then
have
a
C-section
are
still
looked
at
as
far
as
patients
as
a
birth
center.
D
Yes,
but
it's
still
convoluted,
because
if
you
think
you
need
a
C-section,
are
you
going
to
have
a
C-section?
You
would
go
to
the
hospital
in
the
first
place,
so
you
to
make
the
stats
correctly.
You'd
have
to
say
how
many
women
went
into
a
hospital
not
expecting
a
C-section
are
the
chance
of
it
compared
to
a
birthing
center
would
be
the
proper
way
that
I.
Just
think
that
you
say
one
in
ten
compared
to
whatever
a
hospital
is,
is
not
quite
apples
to
Apple.
I
Thank
you
for
bringing
that
up.
Senator
nemes,
the
primary
point
that
we're
acknowledging
is
that
the
opportunity
for
a
a
birthing
process
that
allows
for
low-risk
women
to
have
a
vaginal
delivery,
and-
and
it
is
not
to
we
weren't,
even
comparing
the
two.
We
were
just
acknowledging-
that
the
amount
of
four
and
ten
forty
percent
is
a
very
large
percentage
and
we
like
to
see
it
a
much
much
lower
percentage
than
that
of
C-sections
for
low-risk
women.
C
I
Thanks
for
asking
I
have
to
confess
that
I'm,
a
freshman
and
I
was
very
disappointed
in
the
lack
of
communication.
I
received
zero
communication
from
the
Kentucky
Hospital
Association,
so
the
changes
and
adjustments
I
did
reach
out
to
the
president
of
the
St
Elizabeth
Hospital
Network,
and
requested
input
Senator.
A
I
don't
mean
interrupt
I
think
we
need
to
get
them
on
here
in
just
a
minute
and
then
maybe
we
can
we'll
just
go
directly
with
yeah
yeah
they've
signed
up
here,
so
we'll
just
get
them
on
and
hear
right
from
them.
Sure
I
want
to
recognize
Senator
Douglas.
So
first,
if
you
had
something
just
for
this
lady.
A
Out,
that's
what
I
thought
yeah!
Okay!
Let's
do
that!
Let's
change
gears
here
and
I'm!
Looking
here
and
I
see
the
Kentucky
Hospital
Association
has
signed
up
to
speak.
Why
don't
you
come
forward
and
then
who
else
wants
to
speak
against
this
legislation,
got
what.
A
A
I
have
a
distinguished
looking
group
of
people
here.
I
want
to
point
out
that
I
have
to
point
out.
As
chairman,
we
did
have
an
interim
hearing
on
this.
It
was
publicized
and
I
think
people
need
to
know
that,
but
to
Welcome
to
the
committee
I'm
going
to
start
the
clock
for
15
minutes.
Just
like
the
other
side,
don't
feel
compelled
to
use
all
your
time.
There's
no
penalty
for
not
using
all
your
time,
but
we'll
start
the
clock
introduce
yourselves
for
the
record
and
proceed
with
your
testimony.
M
M
Be
back
it's
the
first
time
I've
ever
been
accused
of
not
being
loud
enough.
Will
Milan
I'm
a
family
physician
I
practiced
in
a
collaborative
practice
with
nurse
midwives
in
Eastern
Kentucky
for
20
years
and
I'm.
Currently,
the
senior
vice
president
for
patient
safety
and
quality
at
Sinclair
Healthcare
in
Moorhead.
N
O
Thank
you
senator
schickel,
for
having
us
today.
We
did
think
that
our
position
was
well
known
and
we
didn't
testify
earlier,
because
we
thought
it
was
very
well
known.
I
know
we
I
think
met
with
Senator
funky
fromer
in
the
interim.
Some
of
our
advocacy
team
did
and
discussed
this
issue,
so
we
did
think
that
our
position
was
well
known,
but
we
want
to
thank
you
for
hearing
us
today
very
much,
and
we
appreciate
that.
It's
been
pointed
out
that
freestanding
birthing,
centers
are
allowed
to
be
built
in
the
state.
O
I
think
there
was
a
misconception
that
legislation
was
needed
to
allow
them,
but
they
already
can
be
built
under
current
law
and
looking
at
the
record
since
1983
six
applications
for
a
con
for
birthing
centers
were
filed
with
the
state
and
three
of
those
were
granted
and
three
of
those
were
denied.
So
it's
clear
that
certificate
of
needs
can
be
granted
for
birthing
centers
when
there's
basic
patient
protections
built
into
the
plan
and
there's
communication
with
the
local
hospitals
and
Physicians
these
exam.
O
O
If
a
complication
during
birth
arises,
a
quick
transfer
from
the
birthing
center
to
the
hospital
is
going
to
be
critical
to
the
health
and
life
of
the
mother
and
child,
and
without
those
written
transfer
agreements
in
place,
a
complicated
birth
could
easily
lead
to
the
death
of
the
mother.
The
baby,
or
both
the
proposed
legislation
and
committee
substitute,
does
not
require
such
an
advanced
written
transfer
agreement
with
a
Kentucky
hospital.
O
In
fact,
the
national
accreditation
standards
referred
to
in
the
legislation
specifically
State
and
I
quote.
A
written
agreement
is
not
required
between
birth
center
and
receiving
facility.
A
birth
center
must
only
notify
the
hospital
of
the
impending
transfer,
the
mode
of
Transport.
The
expected
time
of
arrival
and
upon
arrival,
the
birth
center
and
midwife
gives
a
verbal
report
and
a
legible
copy
of
relevant
prenatal
and
labor
health
records.
O
In
other
states,
we
have
seen
the
freestanding
birthing.
Centers
have
left
a
number
of
dead
or
injured
patients
and
there's
been
little
accountability.
These
operations
have
difficulty
obtaining
malpractice
insurance
and
if
an
injury
or
death
arises,
they
have
simply
declared
bankruptcy
and
walked
away.
O
We
appreciate
that
the
committee
substitute
calls
for
the
cabinet
to
address
requirements
for
malpractice
insurance
for
the
center.
However,
it
is
not
clear
from
the
language
that
if
the
requirement
would
be
extended
to
The
Midwives
practicing
in
the
center,
not
just
the
center,
but
the
midwives
practicing
in
the
center,
which
is
crucial
to
protect
patients.
O
It's
not
also
clear
whether
the
committee
substitute
intends
to
allow
a
default
to
the
accreditation
standards
which
consider
a
center
to
be
in
compliance
and
accredited
without
the
center
or
The
Midwives,
actually
having
coverage
the
accreditation
standard,
State
and
I
quote
if
birth
center
and
or
clinical
providers
or
clinical
staff
are
not
covered
by
medical
liability.
Insurance
clients
are
notified
of
this
fact.
O
Both
the
facility
and
each
clinical
provider
is
fully
insured
for
medical
malpractice
and
the
facility
is
required
to
have
an
active,
written
transfer
agreement
with
the
local
Ambulance
Service
and
the
local
Kentucky
hospital
Vanderbilt
University
Hospital
is
one
of
the
ones
in
Tennessee
There's.
The
one
in
West
Virginia
is
also
earned
owned
by
a
Hospital
Vanderbilt
University
Hospital
operates
a
freestanding
birthing
center
within
a
mile
of
its
hospital
in
Nashville,
it's
operated
under
the
direction
of
an
obstetrician.
O
Hospitals
are
not
opposed
to
patients
having
options,
but
our
first
concern
is
always
with
the
patient's
health
and
safety.
Removing
freestanding
birthing
centers
from
con
would
be
a
misguided
step
in
a
state
with
some
of
the
highest
infant
and
maternal
mortality
rates
in
the
country.
Kentucky's
hospitals
call
on
the
legislature
to
maintain
the
Integrity
of
the
con
program
for
freestanding
birthing
centers,
and
while
the
non-substantive
review
standard
is
a
very
low
bar,
it
is
critical
for
the
health,
safety
and
lives
of
our
patients,
and
so
with
me
today.
O
N
Thank
you
and
thank
you
for
allowing
me
to
come
and
speak
what
I'm
most
passionate
about
today,
I'm
coming
to
you
from
the
heart
of
a
provider,
a
physician
in
the
Commonwealth
of
Kentucky,
as
well
as
a
patient
who
has
been
delivered.
All
three
of
my
babies
were
born
natural
childbirth
by
a
a
nurse
Midwife.
So.
N
Talk
about
time
left
I
see,
okay,
people
sitting
there
great
I'll
go
very
quickly,
as
you
can
tell
I'm,
just
really
passionate
about
birth
in
Kentucky
I
support
freestanding
birth,
centers
I
support
the
Midwifery
model
of
care.
I
do
not
support
an
unregulated
freestanding
birth
center
I
feel
that
there
needs
to
be
collaboration
and
oversight
by
your
birthing
hospitals
very
similar
to
the
Vanderbilt
model.
N
My
concerns
come
out
of
being
a
physician
who
is
on
the
receiving
end
of
what
is
sometimes
very
unregulated.
Birth
I
have
big
concerns
about
maternal,
as
well
as
neonatal
safety
in
this
situation
in
a
in
addition
to
what's
already
been
presented
about
the
bill,
the
lack
of
any
regulation
of
distance
from
a
birthing
Hospital
concerns
me
the
lack
of
any
oversight
of
consistently
risking
out
high-risk
patients.
N
I
do
want
to
acknowledge
that
I
realize
we
have
maternity
care
deserts
here
in
the
state
of
Kentucky.
I
am
a
past
president
of
the
Kentucky
perinatal
Association,
which
is
a
collaborative
association
between
nurses,
Hospital
administrators
midwives,
social
workers,
Public
Health
experts
and
I
have
worked
hard,
alongside
with
the
March
of
Dimes,
to
improve
that
letter.
D
grade
I've
been
part
of
a
lot
of
State
initiatives.
N
So
it's
not
that
I'm
anti-midware,
it's
not
that
I'm
anti-birthing
center.
It's
that
there
needs
to
be
regulation
and
oversight
to
ensure
that
the
women
of
Kentucky
are
provided
safe
and
compassionate
birthing
options.
I'll
leave
it
at
that.
I
will
say
and
I
would
like
to
say
that
I
work
in
a
hospital
my
babies
do
skin
to
skin.
In
my
c-section
rate
is
consistently
10
percent
or
less
so
I
can
say
from
the
9
out
of
10
women
that
achieve
vaginal
birth.
I
have
those
same
statistics
in
a
hospital
setting.
M
I
want
to
not
repeat,
because
that's
your
per,
that
is
your
tradition,
but
ditto
and
I
want
to
just
show
one
example
of
where
my
concern
about
patient
safety
is
again
I'm.
I
I
actually
believe
birthing
centers
have
a
role,
but
the
leading
cause
of
maternal
death
mother's
death
in
the
world
in
childbirth
is
bleeding
to
death
in
the
United
States.
That
is
not
true.
It
was
true.
A
hundred
years
ago,
my
great-grandmother
bled
to
death
at
home
after
delivering
my
great
aunt
in
the
city
of
New
York.
M
So
it's
a
personal
thing
so
and
as
an
instructor
on
Advanced
life
support
and
obstetrics,
which
is
a
patient
safety
course.
We
do
teach
about
the
management
of
bleeding
after
birth,
because
bleeding
after
birth
cannot
be
predicted.
It
has
to
be
expected
with
every
delivery
and
although
many
cases
can
be
managed
right
away
through
good
technique
and
medication,
the
worst
cases
and
that's
what
you
guys
have
to
think
about
I
I-
do
know
that
this
is
something
that
we
don't
want
to
be
scaring
anybody.
M
However,
you
have
to
think
about
the
women
who
need
blood
and
need
immediate
treatment
and
a
resuscitation
environment
and
need
shock
treatment
for
Hemorrhage,
and
so
my
thing
is
I
want
to
make
sure
these
birthing
centers
have
close
relationships
that
you
have
a
highly
functioning
Advanced
EMS
system
that
can
manage
that.
So
something
in
an
urban
environment
is
probably
reasonable.
M
Sandy
Hook
in
Elliott
County
Kentucky.
It's
not
going
to
happen.
It's
not
personal
I've
been
their
director
I'm,
just
telling
you
and
it's
a
45
minute
drive
to
the
hospital
they're
going
to
die.
The
leading
cause
of
maternal
death
in
this
state
is
substance
use.
It
is
not
currently
bleeding
to
death.
I.
Don't
want
to
contribute
to
that
number.
All
three
of
my
kids
also
were
Midwife
from
Midwife
deliveries.
Thank
you
very
much
for
allowing
us
a
chance
to
talk
to
you
today.
G
L
I
appreciate
the
opportunity
as
well
again,
my
microphone
wasn't
on
Dr
Jody
Prather
from
Baptist
Health
and
I'm.
A
family
physician
I'll
be
brief,
because
I
know
we're
short
on
time.
Our
physicians
here
gave
us
a
good
clinical
picture.
I'll
come
more
from
being
the
strategy
officer,
who's
in
charge
of
a
lot
of
the
processes,
around
transfers
and
handoffs
and
continuums
of
care
for
our
nine
hospitals,
which
is
we
deliver
more
babies
than
anyone
else
in
the
Commonwealth
and
we're
not
saying
birthing
centers
are
inappropriate.
L
L
If
the
processes
are
not
in
place
from
the
handoff
to
the
physician
to
the
EMS,
to
making
sure
that
those
over
tax
services
are
ready
and
that
the
handoff
to
The
Physician
and
the
hospital
is
so
good,
I
spend
most
of
my
time
making
sure
even
inside
of
our
walls
that
the
right,
handoffs
and
Continuum
of
Care
happen
with
patients.
And
there
are
still
risk
points
and
we
practice
it
every
day
and
the
chance
that
a
non-regulated
facility
could
be
set
up
with
the
risk
associated
with
childbirth.
L
P
Good
morning,
Dr
Dan
ghoulson
Chi
St
Joseph
Health,
just
to
elaborate
on
a
couple
of
points
that
my
colleagues
have
made
when
when
risk
can
be
predicted,
it's
very
easy
to
manage
that,
and,
and
certainly
in
this
model
in
in
high
risk
cases,
those
would
be
routed
to
appropriate
centers
and
appropriate
levels
of
care.
A
However,
this
is
important.
Testimony
I
just
want
to
reiterate.
As
chairman.
We
should
have
heard
this
during
the
interim
in
this
committee
when
something
goes
on
the
interim
agenda
we're
serious
about
it.
We
don't
hear
any
bills
unless
they've
been
heard
during
the
interim
during
session,
but
out
of
respect
for
this
important
testimony,
I'm
going
to
put
some
more
time
on
the
clock,
because
I
think
we
do
at
least
I
want
to
hear
all
the
testimony
so
I'm
going
to
go
ahead
and
put
10
more
minutes
on
the
clock.
Thank
you,
doctor.
P
Thank
you,
Mr
chairman
in
in
the
case
of
hemorrhage.
One
of
the
conditions
that
leads
to
maternal
Hemorrhage
is
a
condition
called
percent.
Placental
abruption
and
the
abruption
Ward
is
not
is
not
a
coincidence
because
it
happens
abruptly.
It
happens
without
warning
and
it's
life-threatening
in
hospitals.
You
may
be
familiar
that
that
we
have
techniques
to
Rally
all
hands
on
deck,
and
so,
if
there's
a,
if
there's
a
fire,
we
call
a
code
red.
P
P
If,
if
a
patient
in
this
instance
of
a
freestanding
birthing
center
is
miles
away
from
a
hospital
I
think
that
we
all
know
just
practically
speaking,
the
the
degree
of
response
is
going
to
be
much
delayed
from
those
that
are
inside
a
hospital.
So
in
in
many
situations
we
identify
a
need
for
health
interventions.
We
identify
a
need
for
for
Health
and
Medical,
Services
and,
and
that
need
is,
is
really
operationalized
by
the
certificate.
P
Indeed
program,
and-
and
so
if
there
is
a
need
in
a
community
in
in
a
in
a
care
desert,
then
it
may
be
appropriate
to
have
these
types
of
of
facilities,
but
because
the
risk
is
significant
and
and
the
risk
can
lead
to
both
maternal
and
to
neonatal
death.
P
A
Be
made
available,
thank
you,
doctor
and
I'm
sure
we're
going
to
have
some
questions
so
who
has
questions.
K
Thank
you,
Mr
chairman
yeah.
We
have
I,
don't
have
a
lot
of
questions.
I.
Think
you
guys
I
want
to
thank
you
for
coming.
I
want
to
thank
everyone
who
spoke
this
who
has
spoken
this
morning.
I
think
you've
gave
some
very
valuable
you've
each
given
very
valuable
information
as
a
senator
sitting
up
here
and
as
a
practicing
physician
for
more
years
and
I'm
that
I'm
going
to
share
I
I,
see
this
bill
in
two
different
parts.
K
I
see
this
as
a
bill
about
freestanding
birthing,
centers
and
a
and
a
bill
about
certificate
of
need
and
I'm,
not
I'm,
not
going
to
address
that
Divergence,
but
I
just
wanted
to
put
that
out
there.
Four
things
if
I
may
Mr,
chair
and
I'll
say
them
very
quickly,.
K
Thank
you,
Mr,
chair.
First
of
all,
birthing
centers.
We
look
at
birthing
centers
to
cut
costs,
I
love
to
cut
costs.
Anyone
who
knows
me
here
in
the
Senate
knows
I
want
to
cut
costs
because
I
want
our
taxpayers
in
the
Commonwealth
of
Kentucky
to
stop
carrying
all
that
burden.
That
is
those
who
are
producing
income,
but
not
at
the
cost
of
lives
in
any
anyone.
K
Who's
sitting
in
that
chair,
especially
the
Physicians,
know,
it's
a
scary
place
to
be
medicine's
a
lot
of
fun,
but
it's
a
scary
place
to
be
at
times
number
two.
There
is
a
lack
of
awareness.
I
worked
as
an
emergency
room
physician
for
four
years.
Mr
chair,
it's
scary,
as
hell
to
get
these
calls
in
the
emergency
room
when
the
information
is
not
accurate.
K
K
Q
Mr
chairman
I'm
really
conflicted
on
this
bill
and
where
we
are
full
disclosure
I'm
the
one
who
suggested
to
set
Senator
funky
frohmeyer
that
we
send
this
bill
back
to
committee
and
work
on
a
committee
sub
with
the
four
bed
limit
and
some
of
the
elements
of
the
floor,
amendments
that
were
that
were
filed
and
she's
done,
that
and
and
by
the
way,
she's
doing
a
great
job
working
this
bill
and
her
bills,
but
I'm
I'm
conflicted
because
the
kha
appears
to
continue
to
be
opposed
to
it
and
I
do
want
to
throw
this
suggestion
out
there.
Q
It's
very
likely
that
we're
going
to
have
a
task
force
or
a
working
group
or
one
or
two
committee
meetings
dedicated
to
the
certificate
of
need
issue.
This
summer,
several
legislators
and
other
bills
have
brought
up
con.
Those
bills
are
not
moving
forward
this
session,
but
I
do
think
it
has
prompted
the
likelihood
that
there
will
be
a
full-on
discussion
about
con
during
the
interim
and
I
think
that
the
the
main
issue
I
have
with
this
bill
is
the
camel's
nose
Under
the
Tent
as
it
relates
to
con.
Q
A
Ditto,
a
couple
of
things
I
want
to
say
as
chairman
of
the
committee.
First
of
all,
when
a
bill
comes
back
to
committee,
that
doesn't
bother
me
a
bit.
I
think
that's
part
of
the
committee
process.
I
would
much
rather
do
it
that
way
than
work
it
out
on
the
senate
floor,
work
it
out
in
caucus.
So
that's
part
of
the
committee
process.
I
welcome
committees
back
in
in,
but
I
do,
but
but
I
would
like.
I
would
have
liked
to
have
seen
seen
you
all
engaged
earlier.
A
A
Yes,
we
did
adopt
the
sub.
That
was
first
thing,
I'm
gonna.
Let
since
this
group
got
plenty
of
leeway
on
the
time
and
the
other
side
did
ask
to
be
able
to
do
a
rebut
I
think
that's
only
fair,
since
they
only
used
a
fraction
of
their
time,
and
they
were
here
during
the
interim.
So
I'm
going
to
ask
the
other
group
to
come
up
for
rebuttal.
A
Okay,
we
got
some
new
players,
it
looks
like
I.
Wasn't
anticipating
that
so
I
want
to
emphasize.
This
is
rebuttal.
J
I'm
Mary
Catherine
delauder
with
the
Kentucky
birth
Coalition,
have
spoken
to
you
all
before.
Some
of
these,
ladies
are
faculty
at
Frontier,
nursing
University,
and
they
teach
classes
that
deal
with
things
like
Hemorrhage,
so
they
can.
They
are
the
experts,
which
is
why
I
asked
them
to
be
here
today
to
answer
any
questions
related
to
that.
We'll
start
off
by
saying
that
certificate
of
need
is
is
really
not
about
safety.
That's
what
the
licensure
portion
of
this
is
about.
J
Birth
centers
are
already
permitted
in
Kentucky
to
say
that
we're
going
to
have
unregulated
birth
centers,
as
was
stated
several
times
by
the
Folks
at
the
table
before
us,
that's
just
not
true,
they're,
already
regulated
in
Kentucky,
and
we're
actually
asking
for
more
regulation
by
increasing
the
licensure
requirements
of
all
those
con
applications.
Since
the
1980s
there
have
been
none
of
those
successful
in
the
last
20
years.
The
one
the
only
one
of
those
that
opened
was
the
one
from
the
80s
in
1983..
So
to
talk
about
things
that
okay.
J
Years
ago,
it's
not
necessarily
so
con
is
sometimes
called
the
competitors,
veto
and
I
think
we
can
see
that
the
hospitals
are
very
opposed
to
this
and
they
don't
want
to
lose
their
opportunity
to
veto
that
these
same
licensed
midwives
are
already
practicing
in
Kentucky
in
the
home
setting
they
are
practicing
without
oversight
of
Physicians.
J
J
The
malpractice
requirements
we
did
add
some
language
regarding
that
in
the
sub,
as
Senator
phonemeier
referenced
I
would
point
out
that
there,
as
far
as
I
can
tell-
and
no
one
has
corrected
me
on
this-
there
are
no
malpractice
limitations
or
requirements
on
any
provider
types
in
statute.
It's
a
common
misconception
that
Physicians
are
required
by
law
to
carry
malpractice
insurance
and
we
discovered
that
that
is
not
true.
When
we
were
doing
the
licensing
of
the
certified
professional
midwives
a
few
years
ago.
J
They
carry
it
for
other
reasons,
for
example,
to
participate
in
Medicaid
or
to
accept
private
insurance
or
because
it's
required
by
the
policy
of
the
hospital
where
they
work.
But
the
state
does
not
require
that
by
law
and
I'm,
not
aware
of
any
statutes
that
require
any
other
facility
types
to
carry
any
malpractice
insurance.
Yet
we
have
added
language
that
will
direct
the
regulations
to
address
this.
J
We
do
only
have
20
of
the
birthing
hospitals
in
Kentucky
that
offer
nurse
midwives,
who
have
privileges
to
actually
deliver
babies
in
the
hospital.
So
while,
yes,
we
do
have
some
Midwifery
services
in
the
hospital.
It
is
very
limited.
J
Regarding
the
distance
requirement
to
a
hospital
I,
don't
quite
understand,
because
there
were
separate
floor
amendments
filed
on
this
and
I
assume
kha
asks
for
those
four
amendments,
but
again
they
didn't
come
and
talk
to
us
or
Senator
frommeyer.
So
we
just
assumed
that
maybe
they
had
asked
for
those
floor.
Amendments
there's
one
floor
amendment
that
requires
a
birth
center
to
be
within
five
miles.
There's
another
floor
amendment
that
says
a
birth
center
cannot
be
within
60-minute
ambulance
ride.
So
one
says
it
must
be
close.
J
One
says
it
must
be
far
away:
I,
don't
know
if
it's
a
drafting
error,
because
no
one
proof
read
the
Amendments
but
I'm
not
sure
what
we're
looking
for
there,
because
there's
two
different
floor
amendments
on
that
and
as
far
as
addressing
emergencies
like
Hemorrhage
I'm,
going
to
let
either
of
you
address
very.
A
R
Dr
D
Polito
I
am
a
faculty
at
Frontier,
nursing
University
with
26
years
of
experience
as
a
certified
nurse.
Midwife
I
would
just
testify
that
we
are
in
agreement
with
many
testimonies
about
safety
and
we
fully
recognize
that
complications
can
and
do
occur
not
only
in
birth
centers
but
in
homes,
but
they
also
occur
in
hospitals
as
well.
S
Good
morning,
hi
I'm
Victoria
burslem
I'm,
a
certified
nurse
Midwife
and
I
teach
at
Frontier
nursing,
University
I've
been
a
midwife
for
over
40
years.
I
was
a
practice
manager
at
a
very
large
OB
GYN
Hospital.
In
Atlanta
we
had
10
midwives
and
11
Physicians
I've
also
practiced
and
gave
birth
at
a
birth
center
worked
for
three
years
in
Delaware,
so
I
speak
from
the
perspective
of
safety
and
I.
I
can't
agree
more
with
what
the
the
Physicians
alluded
to.
What
I
would
refer
you
to,
rather
than
anecdotal
fear
is.
S
What
does
the
research
say?
We
have
a
smart
study.
We
have
a
study
that
we
try
to
have
tried
to
distribute
to
people
from
the
Journal
of
New
England,
the
New
England
Journal
of
Medicine
validating
the
safety
of
birth,
centers
I
I
agree
wholeheartedly
that
con
process
does
not
address
the
safety
issues
that
we're
talking
about.
Hospitals
are
the
then
the
the
place
that
you're
going
to
be
referring
people
for
if
they
need
a
C-section,
if
they
need
high
risk
care
if
they
need
GYN
surgery,
those
these
are
all
going
to
go
to
those
hospitals.
S
What
we
see
the
the
rationale
that's
being
used,
is
this
competitor
Point,
that's
trying
to
say
that
that
we're
going
to
be
in
competitions
with
hospitals,
and
that's
not
the
case.
You
have
to
work
in
collaboration
with
Physicians
and
with
hospitals
to
be
safe.
The
con
process
does
not
address
that.
A
Thank
you
well,
thank
you.
All
any
questions
of
this
group
I
think
we'll
go
ahead
and
vote.
Does
anyone
have
objections
or
want
to
ask
something
else?
I
think
we
have
some
pretty
good
dialogue
here,
I'm
secretary
caldero.
C
I'd
like
to
explain
my
I
vote,
vote
and
explain
I'm
going
to
vote
I
I,
because
I
have
a
tremendous
amount
of
respect
for
the
sponsor
of
this
bill
and
her
partners
that
she's
been
working
with
I've,
worked
with
on
numerous
issues
and
so
I
think
they
bring
a
tremendous
perspective.
We
wouldn't
be
up
here
if
this
perspective
didn't
need
to
be
identified
as
an
option
for
birthing
in
Kentucky.
With
that
being
said,
you
know
it's
also
a
heavy
lift
when
the
hospital
Association
comes
out
against
it.
C
K
I'm
going
to
pass
on
this
because
I
don't
necessarily
want
to
kill
it,
but
I
I.
This
is
not
a
competitor,
Bill
I'm.
We've
got
this
idea
in
our
society
that
if
somebody
wants
to
do
something
that
we
do,
that
everyone
gets
upset
and
throws
up
their
arms
and
all
of
a
sudden,
it's
a
competitor
Bill.
We
we
have
to
move
away
from
away
from
that.
Mr
chairman
people
in
healthcare,
that
is
Physicians,
look
at
things
differently
than
a
lot
of
the
regular
population,
not
a
criticism,
just
an
observation.
Thank
you.
Mr
chair.
G
G
T
So
I
I
too,
am
very
conflicted
about
this
pill
and
and
I
say
that
since
I'm,
a
very
new
to
the
issue
and
I
I
very
much
respect
what
Frontier
is
doing
and
I
want
to
be
a
strong
supporter
of
your
success,
I
think
having
a
center
on
there
is
really
important
and
I'm
for
it
and
I
voted
to
support
it.
The
last
time
this
came
out
of
committee
and
I
want
to
thank
Senator,
Fred
Meyer
as
well,
because
I
think
this
is
the
sub
is
a
much.
T
G
D
That's
a
different
issue
that
we'll
take
up
later
I
think
it's
a
freedom
of
choice
as
long
as
you
know
the
safety
issues
of
it,
because
it
it
isn't
as
safe
as
a
hospital
because
of
the
transfer
in
that
I
am
a
little
concerned
about
the
liability
that
the
hospital
is
going
to
have
to
pick
up
when
they
pick
up
the
problems,
all
the
problems
that
they
would
have
there
if
the
weren't
in
birthing
centers
but
I
I'm
voting.
Yes,
because
I
think
it's
a
freedom
of
the
choice
of
the
woman.
Q
I'm
going
to
vote
no
because
I,
just
don't
think
this
issue
is,
is
ripe
yet
and
I
I'll
be
honest.
I,
don't
think
we
have
the
votes
to
pass
it
on
the
floor.
I
voted
yes
last
time
to
get
it
out
of
committee
and
I
suggested
this
Senator
funky
frommeyer
that
she
take
this
path
and
she's
done
an
excellent
job.
Q
Moving
the
issue
forward,
but
there
and
and
the
committee
sub
is
good
and
it
moves
it
in
the
right
direction,
but
I
think
I
would
be
disingenuous,
knowing
that
we're
probably
going
to
take
a
deep
dive
into
this
issue
during
the
interim,
it's
going
to
get
out
of
committee
today,
so
I'm
gonna
I'm
gonna
vote.
No,
because
I
just
don't
think
it's
ready
for
prime
time
yet.
A
U
You
I
believe
in
our
free
market
system
here
in
the
economy
that
that
you
know
there
ought
to
be
good
competition,
Fair
competition
for
services
for
goods
and
I.
Think
that's
also
true.
When
it
comes
to
to
birthing.
We
all
have
to
acknowledge
that
that
birthing
is
inherently
risky.
You
know
what's
been
testified
here
today
that
that
you
could
have
what's
deemed
to
be
a
safe
birth
and
then
something
go
wrong.
It's
certainly
true
I
mean
birthing
hazardous
risk.
We
all
know
that.
U
However,
we
have
to
also
acknowledge
that
that
most
people
who
were
born
in
this
world
are
born
outside
of
a
hospital.
Now
that
wasn't
true,
in
my
case
with
my
three
children,
but
but
most
births
take
place
outside
the
hospital
and-
and
we
can
see
from
looking
at
the
world
that
that's
okay,
Kentucky
does
have
one
of
the
highest
infant
mortality
rates
in
the
state.
U
We're
at
we're
at
the
bottom
and
Dr
Douglas
has
pointed
out
that
that's
largely
due
to
substance,
abuse
and-
and
that
could
be
true,
but
but
we
have
that
we
don't
know
where
these
birthing
centers
will
will
add
to
that
problem
or
correct
that
problem,
but
I'm
certainly
willing
to
give
it
a
try,
I
guess
what
what
makes
me
want
to
say.
Yes,
is
that
42
States
already
do
this
and
not
one
of
them
have
said
this
was
a
bad
idea
and
have
reversed
course.
U
So
we
know
it
works
here
in
the
country,
no
I
just
I
just
hate
it
when
Kentucky's
always
bring
up
the
rear,
rather
than
leading
I
see
Kentucky
lead.
This
is
this.
Is
my
home
state
I
grew
up
here
and
yet
we're
one
of
the
last
states
to
to
go
down
this
path,
but
I
think
we
got
to
go
down
this
path.
Working
other
states
it'll
work
year,
work
here,
so
for
all
of
those
reasons,
Mr
chair,
you
know
I
vote
Yes
on
this
measure.
U
A
A
A
Senate
Bill
67,
as
amended
by
committee,
substitute
number
one
is
passed
with
favorable
expression
that
same
should
pass.
Congratulations
and
I
want
to
thank
everyone
here.
For
this
hearing
and
the
decorum
that's
been
expressed,
I
think
we've
had
a
good
hearing
without
a.
If
there's
any
objections
does
any
member
have
anything
they
want
to
add
before
we
adjourn
without
objection.
We
Stand,
adjourned.