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From YouTube: House Health Committee- March 24, 2021
Description
House Health Committee- March 24, 2021
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Okay,
thank
you.
Thank
you
very
much,
mr
chairman
and
members.
It's
good
to
be
with
you
good
to
be
with
you
you
all
again
this
afternoon.
My
name
is
steven
smith.
I
serve
as
the
director
of
tenncare
and
we
have
other
members
of
our
leadership
team
that
are
up
here
with
me
today
and
they
will
introduce
themselves
as
as
we
get
into
questions
and
and
they
respond.
C
We've
already
spent
some
time
this
session
talking
about
this
theme
of
the
past
present
and
future
of
tenncare,
and
we're
excited
we're
optimistic
about
the
present
stage
of
where
we
are
with
with
10
carat
and
about
that
future.
But
we
also
know
that
we
have
challenges
in
front
of
us
and
we're
spending
a
lot
of
time
trying
to
learn
from
our
past
so
that
we
don't
make
some
of
the
same
mistakes
that
we've
made
and
that
we
can
learn
from
the
successes
that
we've
had
over
the
past
couple
of
decades.
C
It
really
wasn't
that
long
ago,
when
double-digit
growth
trends
and
a
very
unstable
market
in
terms
of
our
health
plans,
and
we
also
struggled
with
managing
our
utilization,
those
things
all
together,
threatened
the
very
existence
of
tenncare
and
so
back
in
2004,
the
executive
branch
and
the
legislative
branch
at
the
time
worked
together
to
make
some
major
reforms
to
the
program
and
oftentimes.
The
the
reduction
in
the
numbers
of
members
served
gets
the
most
attention
when
we
talk
about
those
reforms,
but
really
it
was.
C
C
There's
often
this
idea
that
controlling
the
rising
cost
of
health
care
by
necessity
means
that
you
are
decreasing
access
and
you're
decreasing
quality,
and
actually
we
would
contend
that
the
opposite
is
true.
Those
things
actually
go
hand
in
hand
and
by
controlling
the
rising
cost
of
health
care
and
getting
a
handle
on
these
things.
C
You
can
actually
enhance
services,
enhance
benefits
and
serve
more
people,
and
we've
proven
that
as
a
tenncare
program
over
the
last
two
decades,
so
controlling
cost
growth,
coordinating
care
and
properly
managing
utilization
means
that
you
can
do
more
and
and
it's
not
about
doing
less
and
that's
evidenced
by
some
of
the
quality,
metrics
and
performance
measures
that
we've
seen
in
tenncare
over
the
last
several
years.
You
can
see
some
of
these
highlighted
on
the
screen
childhood
immunizations
are
up.
Screenings
are
up
our
neonatal
abstinence
syndrome.
Births
are
down
significantly.
C
94,
and
certainly
one
of
our
best
measures
when
we
look
at
quality
and
access,
one
of
our
best
measures
is
the
grade
that
our
own
members
give
us
with
that.
We'll
move
into
our
cost
increases
for
fy22,
our
requested
cost
increases
and
I'm
not
going
to
go
through
all
these
individually,
but
I'll
just
highlight
just
a
couple.
C
So
first
I'll
call
your
attention
to
the
medical,
inflation
and
utilization
number
and
you
all
are
accustomed
to
seeing
this
every
year.
This
is
our
medical,
inflation
and
utilization
increase.
This
is
our
anticipated
trend
or
our
growth
and
I'll
note
that
this
represents
a
1.42
growth
trend,
which
is
the
lowest
in
recent
memories,
the
lowest
that
we
can,
that
we
can
remember
and
that
we
can
find
on
record.
C
We
talk
a
lot
at
ten
care
about
our
success
in
managing
our
trend
and
our
cost
growth,
and
we
talk
we
talk
about
why
that's
so
important
to
the
state
budget
as
a
whole.
This
is
where
that
shows
up.
It
shows
up
in
this
trend
number
to
put
that
in
better
perspective,
if
tenncare
had
performed
at
the
state
medicaid
average
in
terms
of
our
cost
growth
over
the
past
decade,
we
would
have
spent
an
additional
2
billion
dollars.
C
So
the
point
of
all
that
is
to
note
that
the
the
cost
of
tenncare
being
average
it
there
are
real
costs
there.
They
are
substantial.
We
don't
want
to
be
average
at
ten
care
and,
frankly,
we
don't
have
the
luxury
of
being
average
and
when
the
state,
if
we
are
average,
you
can
see
that
we'll
we'll
have
these
really
large
cost
impacts
and
that
impacts
the
state
as
a
whole.
C
The
first
is
a
dental
pregnancy
program
which
will
extend
dental
coverage
to
pregnant
women
21
and
over.
So
we
know
from
research
that
oral
health
in
children
and
specifically
early
childhood
cavities,
are
directly
related
to
the
bacteria
that
is
transmitted
from
the
mother
to
the
child
and
treating
these
conditions
today
often
results
in
very
high
cost
settings
like
the
emergency
room
and
oftentimes.
There's
anesthesia,
that's
associated
with
that
and
both
of
those
things
carry
increased
clinical
risk.
So
we
believe
that
this
coverage
initiative
will
make
a
big
difference.
C
We
actually
think
it
will
save
dollars
in
the
long
term,
while
also
improving
the
quality
of
care.
The
second
item
would
extend
postpartum
coverage
for
10
care
members
from
60
days
to
12
months.
We
know
that
maternal
mortality
remains
an
issue
that
it's
nationwide
and
certainly
tennessee,
is
no
exception.
C
The
po,
the
late
postpartum
period,
is
critically
important.
It
remains
a
vulnerable
time
in
the
health
of
the
mother
and
and
also
the
child.
So
this
initiative
is
is
really
about
it's
as
much
about
the
child
as
it
is
the
mother.
We
want
to
set
that
child
up
for
success
from
birth,
and
we
think
that
this
initiative
will
play
a
large
part
in
that
you
heard
the
governor
at
his
state
of
the
state,
address
talk
about
the
adoption
initiative
and
this
would
provide
10
care
coverage.
C
Excuse
me
for
adopted
youth,
which
we
believe
will
be
an
important
tool
in
facilitating
more
adoptions.
Presently
we
have
a
number
of
dcs
children
who
do
not
qualify
for
any
public
adoption
assistance,
and
this
can
create
a
barrier
to
those
adoptions
where
the
children
have
to
rely
on
the
insurance
coverage
that
the
adopting
parents
have.
C
So
we
want
to
eliminate
any
burdens
that
we
can
here
and
we
think
this
is
a
tool
one
of
the
tools
that
can
eliminate
those
burdens
on
the
reduction
side.
I'll
highlight
a
couple
of
points.
First,
we
are
proud
to
once
again
play
a
large
role
in
the
overall
necessary
reductions
at
the
state
level.
So
this
year
for
fy22,
the
reductions
in
tenncare
represent
57
of
the
total
reductions
that
are
contained
in
the
state
budget.
C
Second,
we've
been
able
to
propose
those
reductions
with
minimal
impact
on
our
tenncare
members,
so,
for
example,
you'll
see
the
large
reduction
in
the
pharmacy
trend.
That
is
actually
a
reflection
of
our
of
our
actual
expenditures.
Over
the
last
couple
of
years,
trends
have
moderated
substantially
in
in
pharmacy
we're
doing
a
better
job
of
our
rebate
collections,
we're
doing
a
better
job
just
in
our
overall
management
of
our
program,
and
this
will
have
no
impact
on
our
members
or
our
providers.
C
You
also
will
see
at
the
bottom
the
fmap
rate
change.
This
is
our
federal
matching
percentage
this
year
that
works
to
our
advantage.
This
is
strictly
a
federal
calculation
and
it
looks
at
tennessee
relative
to
the
rest
of
the
country,
and
then
every
year
we
get
a
matching
rate
from
the
federal
government
and
for
the
second
year
in
a
row,
this
works
to
our
advantage,
the
90-day
refill
item.
This
makes
permanent
a
policy
that
was
put
in
place
when
the
pandemic
started.
C
C
This
provision
applies
to
our
our
low
cost
generic
medications,
our
maintenance
medications.
It
represents
about
10
percent
of
the
medications
that
are
part
of
our
formulary
at
tenncare
and
then
the
last
item.
I'll
point
to
is
the
340b
item
and
the
340b
program
is
a
it's
a
complex
program.
It's
a
federal
program.
C
It's
recently
received
quite
a
bit
of
attention
at
the
federal
level.
We
know
from
our
oig
auditors
that
this
is
something
that
hhs
at
the
federal
level
is
taking
a
really
close
look
at,
but
at
its
core.
This
item
is
about
making
sure
that
tenncare
as
a
taxpayer-funded
insurance
provider,
is
paying
no
more
for
these
340b
drugs
than
we
should
be
and
the
way
that
we
do.
C
That
is
we
ensure
that
we
are
collecting
all
of
the
rebates
that
we
are
eligible
to
receive
under
the
medicaid
rebate
program,
which
is
a
requirement
of
federal
law
and
also
ensuring
that
we
are
paying
no
higher
than
the
ceiling
price
for
these
340b
drugs,
and
that
ceiling
price
has
been
negotiated
at
the
federal
level
by
the
federal
government
with
the
pharmaceutical
companies.
And
so
we
believe
it's
important
for
us
as
a
taxpayer-funded
medicaid
entity
to
pay
no
higher
than
that
negotiated
price.
E
C
C
The
the
second
bucket
relates
to
the
ceiling
price
and,
to
the
extent
that
those
providers
are
receiving
a
higher
price
currently
or
a
higher
rate
for
those
drugs
than
the
ceiling
price.
Then
it
will
have
an
impact
on
those
providers
and
it
would
it
would
result
in
a
reduction
in
revenue
that
they
are
currently
receiving.
Our
estimate
is
that
is
about
a
50,
50
split.
E
C
C
I
I
think
for
us
it's
really
a
philosophical
decision
to
come
forward
with
this,
because
the
340b
program-
it's
really
a
it's
really
a
distinct
program
and-
and
it
was
born
out
of
the
medicaid
rebate
program
and
and
by
law.
We
are
required
to
to
get
all
those
rebates
and,
up
to
this
point
we
have
not
been
able
to
do
that
because
we
just
haven't
had
the
information
from
the
providers
to
know
when
they
are
providing
a
340b
drug
to
a
medicaid
member.
C
F
C
C
B
B
Thank
you,
chairman
members
of
the
committee.
My
name
is
william
aaron,
I'm
the
chief
operating
officer
for
the
division
of
tenncare,
so
for
the
enhanced
death
map
of
course
went
into
effect
in
march
retroactive
to
january
the
first
so
for
state
fiscal
year
2020,
which
of
course
ended
june
30..
We
had
six
months
worth
of
enhanced
death
map.
The
amount
that
we
received,
that
you
know
that
was
sort
of
against
our
base.
Expenses
was
about
243
million
dollars.
C
C
F
F
C
But
I
want
everyone
to
to
understand
that
once
the
pandemic
ends,
we
will
start
we'll
start
that
gradual
decline
of
our
membership,
but
that's
going
to
be
a
that's.
That's
going
to
be
a
probably
a
12-month
process.
So
it's
not
as
though
you
snap,
your
fingers
and
the
costs
go
away,
and
so
the
the
dollars
that
you
see
here,
the
main
purpose
of
those
are
to
address
the
cost
that
you
see
here.
Now
your
other
question
about
the
additional
f
map
or
matching
dollars
that
are
part
of
this
recovery
act.
C
F
F
C
Well
it
so
if
we
expand,
then
for
the
expansion
population
we
would
get
a
90
match
under
this
provision.
That's
in
the
recovery
act
for
the
existing
population.
We
would
get
an
additional
five
percent
match,
so
it
would
be
our
traditional
65,
65,
plus
five,
so
about
70
and
and
that's
limited
to
two
years
that
provision
is
is
limited
to
two
years.
F
C
A
G
Thank
you,
mr
chairman.
Thank
you
director.
Congratulations
on
a
good
report.
Returning
to
what
leader
gantt
the
questioning
that
he
was
looking
at,
specifically
at
the
rather
large
sum
of
money
that
appears
to
be
in
the
reduced
savings
and
the
reductions.
Looking
at
the
federal
pharmacy
trend
at
minus
48.5
million,
the
state
at
24.6
million.
Does
that
total
of
73.2
million
in
reduced
pharmacy
reflect
the
savings
over
in
the
340b
or
or
are
we
talking
about
a
total
of
a
hundred
and
twelve
thousand
plus
dollars
that
are
total
cuts
in
pharmacy.
C
Right
so
those
are
two
separate
categories:
the
pharmacy
trend-
it
really
is
not,
I
would
argue,
it's
not
a
cut.
It
really
is
just
reflective
of
our
actual
expenditures.
So,
a
couple
of
few
years
ago
the
the
pharmacy
growth
was
just
skyrocketing
and
there
there
were
some
runaway
costs
there
and
we've
done
a
much
better
job
and
those
trends
have
moderated
over
the
years
and
so
we're
able
to
come
forward
with
the
pharmacy
trend
reduction
because
we're
just
we're
just
no
longer
spending
those
kinds
of
dollars
the
340b.
G
All
right,
thank
you,
mr
chairman,
follow
up
and
then
back
to
the
340b
program,
because
I
have
and
my
colleagues
sitting
right
here
beside
me.
We
have
three
hospitals
in
our
county
and
two
of
those
hospitals
get
to
select
their
service
lines.
They
choose
cardiology,
they
choose
oncology,
they
choose
orthopedist,
and
so
they
choose
very
profitable
service
lines.
The
the
county
hospital
chooses
to
be
a
county
hospital,
and
so
they
take
the
meth
babies.
They
take
the
burn
patients
they
take.
G
The
you
know
the
hey
hold
my
beard
as
I
drive
my
atv
into
the
wall.
They
take
the
trauma
and
and
these
this
is
also
the
hospital
that
has
a
very
heavy
and
active
340b
program,
and
so
what
I'm
hearing
is,
at
the
state
level
we're
seeing
about
55
million
dollars
in
cuts
to
hospitals
through
the
the
340b
program.
Is
that
an
accurate
statement.
C
C
G
A
Thank
you
appreciate
you
coming
in
today.
Thank
you
guys
for
coming
here.
There
are
several
other
members
that
have
questions.
I
would
just
ask
that
those
members
submit
you
those
questions,
if
you
don't
mind,
copying
my
office
on
those
and
I
can
get
them
to
all
the
other
members
and
hopefully
that
we
will
have
another
opportunity,
because
we've
got
a
lot
of
discussion
to
have,
but
to
have
you
back
in
front
of
us
to
discuss
more
of
ten
care,
but
thank
you
for
joining
us
today.
Thank.
C
H
H
It
would
take
weeks
not
one
slide
to
cover
all
of
it,
but
I
will
hit
a
few
highlights
for
you.
Since
we
put
these
slides
together,
this
vaccine
number
is
growing
much
higher.
Now
this
says
one
and
a
half
million.
We
are
now
at
close
to
2.3
million
vaccines.
We
now
have
one
and
a
half
million
tennesseans
vaccinated.
H
Something
else
that
we're
proud
of
is
we're
now
approaching
the
seven
million
mark
on
testing.
I
know
that
a
lot
of
focus
right
now
is
on
vaccine,
but
testing
is
still
an
important
part
and
it
was
something
that
was
very
a
very
strong
focus
early
on
and
something
that
a
lot
of
straight
states
struggled
with,
but
we
have
had
a
very
robust
and
free
and
widely
accessible
testing
program
since
the
very
beginning.
H
A
couple
other
programs
that
I'm
particularly
proud
of
one,
is
our
hospital
staffing
assistance
grants.
Programs
that
was
administered
by
dr
mcdonald
who's
joining
me
at
the
table
today.
This
really
helped
provide
a
lot
of
financial
support
for
hospitals
that
were
faced
with
additional
ppe
cost
additional
staffing
costs,
as
well
as
a
concurrent
loss
of
revenue
due
to
lower
volumes
from
the
non-code
space.
H
That
was
helpful,
as
was
the
development
of
covid,
specific
nursing
homes
and
coveted
specific
nursing
units
in
nursing
homes.
That
program
was
also
led
by
dr
mcdonald
and
her
team,
and,
I
think
you'll
remember:
we've
had
a
pretty
strong
focus
on
the
senior
population
throughout
this
entire
response.
They
are
our
most
vulnerable.
They
are
the
ones
who
are
more
likely
to
be
hospitalized
and
to
and
to
pass
away
from
the
virus,
and
so
we
have
had
a
staunch
focus
on
them
throughout.
H
What
we
did
in
nursing
homes
was
to
create
specific
units
where
long-term
care
patients
could
go
if
they
contracted
covet
in
the
nursing
home,
they
could
go
to
one
of
those
units
or
likewise,
if
a
person
needed
to
be
discharged
from
a
hospital
either
to
go
back
to
a
nursing
home
or
a
short
stay.
Some
people
call
that
rehab
skilled
nursing
facility-
they
can
go
there
into
a
unit
where
they
can
be
properly
cared
for,
and
not
only
does
that
help
keep
infections
out
of
the
nursing
home
at
large.
It
helps
hospitals
with
their
throughput.
H
Did
we
do
everything
perfectly
no,
but
did
our
outcomes
in
tennessee
exceed
that
of
our
peers
absolutely,
and
that
means
that
we
have
grandparents
and
aunts
and
uncles
and
brothers
and
sisters
and
parents
who
survived
and
if
they
had
been
in
another
state
they
may
not
have
our
death
rate
in
nursing.
Homes
is
30
percent
lower
than
in
other
states,
and
we
have
been
very
proud
of
that
work
to
protect
our
seniors,
who
we
value
so
much.
H
Thank
you.
We
we
like
the
older
people,
they're
they're,
pretty
special.
We
also
have
continued
other
work
during
this.
You
know.
We've
obviously
had
a
very
singular
focus
throughout
this
pandemic,
but
it
doesn't
mean
that
our
other
work
has
stopped.
We
have
continued
our
operations
as
best
as
we
can.
Some
of
it
has
had
to
be
scaled
back.
Some
of
it
has
had
to
look
a
little
bit
differently
like
a
lot
of
different
businesses,
but
we
continue
to
have
some
public
health
wins
outside
of
the
coveted
space.
H
One
of
them
was
in
our
wic
program,
so
women,
infants
and
children's
that's
the
supplemental
food
program
for
young
young
mothers,
new
mothers
and
young
children
that
did
require
some
in-person
visits
before
we
were
able
to
convert
that
to
a
virtual
platform
and
do
that
through
telehealth,
like
many
other
medical
providers
have
done
and
able
to
still
continue
those
services
and
even
grow
the
program.
We've
also
been
able
to
provide
other
services
by
telehealth,
which
allowed
for
a
large
percentage
of
the
population
to
still
get
their
primary
care
and
still
get
their
public
health
services.
H
Despite
the
limitations
of
the
pandemic.
A
couple
of
statistics
and
then
I'll
get
to
the
budget.
Over
the
last
four
years
we
have
had
a
27
reduction
in
neonatal
abstinence
syndrome
and
a
26
reduction
in
sleep-related
infant
deaths.
So
these
are
two
metrics
that
were
very
high
in
tennessee
and
we
have
not
only
been
able
to
continue
our
progression
on
that,
but
also
sustain
that
throughout
the
pandemic
so
to
the
budget.
H
The
way
that
is
broken
down,
the
two
largest
categories
on
the
top
right
are
local
health
services.
That's
what
you
typically
think
of
when
you
think
of
health
departments
and
the
services
delivered
there,
but
on
the
top
left
is
other
health
services,
things
that
maybe
you're
a
little
more
familiar
with
them
now,
but
a
year
ago
you
might
not
have
known
about
our
very
large
laboratory
services,
public
health
laboratory
services,
as
well
as
our
emergency
preparedness
and
communicable
disease,
and
our
family,
health
and
wellness
program,
and
then
wic,
licensure
and
others
are
self-explanatory.
H
There
this
is
an
important
slide
that
I
want
to
use
to
remind
you
that
pandemic
or
not.
We
have
been
focused
on
our
mission
and
our
mission
is
to
protect,
promote
and
improve
the
health
and
prosperity
of
those
in
tennessee.
That's
very
important
when
you
have
the
link
between
economic
stability
and
health,
and
that
is
not
lost
on
us,
and
so
I
hope
you
have
seen
that
come
through
in
our
work.
H
The
other
thing
that
I
hope
you've
seen
come
through,
and
I
want
you
to
keep
in
mind
as
we're
looking
at
our
budget
priorities
are
our
two
areas
of
focus,
which
are
prevention
and
access.
Prevention
is
your
classic
public
health
upstream
work
and
access
is
something
that
we
have
an
important
role
in
in
tennessee.
It's
somewhat
unique,
whereas
we
provide
a
large
number
of
services
for
uninsured
patients,
so
we
serve
as
a
safety
net
primary
care.
That's
very
unusual.
H
In
fact
I
haven't
found
in
over
two
years
in
this
role
I
haven't
found
any
other
state.
That's
doing
primary
care,
certainly
not
at
scale
like
we
are
so
we'll
talk
more
about
that
in
just
a
minute,
but
even
throughout
the
pandemic.
We
have
strived
to
maintain
these
priorities
so
for
our
cost
increases
this
year.
We're
proposing
four
key
initiatives
that
total
just
shy
of
four
and
a
half
million
dollars.
These
do
align
with
our
strategic
priorities
and
our
mission,
and
I
think,
you'll
see
that
pretty
clearly
as
we
go
through
them
individually.
H
So,
as
I
just
mentioned,
the
first
one
is
two
million
dollars
recurring
to
add
to
the
safety
net
budget.
We
were
grateful
in
the
fiscal
21
year
that
the
governor
and
general
assembly
approved
the
largest
addition
to
the
history
of
the
safety
net
program,
and
we
are
requesting
an
additional
two
million
dollars
record
recurring
to
take
the
base
funding
from
19.9
million
to
21.9
million
we're
currently
serving
about
a
half
million
patient
encounters
per
year.
H
We
do
expect
that
to
grow
as
a
result
of
pandemic,
with
unemployment
with
changes
in
benefits,
people
may
still
be
employed,
but
their
benefit
structure
may
have
changed.
We
do
anticipate
our
need
for
safety
net
primary
care
to
increase,
and
this
would
help
serve
that
need
you
can
see
in
the
bullet
points
there.
This
covers
both
primary
care,
specialty
care,
as
well
as
dental
services.
H
H
H
As
you
can
see,
it's
focusing
on
electronic
cigarettes
or
vaping,
which
is
overwhelmingly
the
most
predominant
mechanism
of
tobacco
use.
Now
amongst
teenagers,
the
other
two
are
smaller.
One
of
them
is
about
94
thousand
dollars
for
retinal
scanner
system.
So,
as
I
mentioned,
we
provide
primary
care
to
a
large
number
of
people
across
the
state
and
about
9
000
of
our
patients
have
diabetes,
one
of
the
tenets
of
screening
for
diabetes
and
making
sure
your
diabetes
is
under
control
is
retinal
screening
for
diabetic
retinopathy.
H
That's
just
looking
in
the
back
of
the
eye
to
make
sure
that
the
eye
is
not
being
damaged
by
diabetes.
Our
current
equipment
is
outdated,
we're
not
able
to
serve
our
current
patients.
This
is
a
pretty
affordable
system.
This
is
for
the
entire
state,
this
little
handheld
devices
all
across
the
state
about
82.
000
of
this
is
non-recurring,
it's
a
one-time
expense
and
then
it's
about
12
000
for
recurring
expense
for
the
software
and
the
licensing,
and
then
the
final
request
is
250
000
for
an
integrated
data
system.
H
H
H
E
E
H
Thank
you
for
that
question,
sir.
That's
certainly
very
important
and
the
short
answer
is
yes:
absolutely.
We
actually
have
a
strategy
session
tomorrow.
Just
about
that
very
thing,
and
right
now
we're
in
the
market
market
research
phase
of
that
entire
advertising
campaign.
Some
of
the
vaccine
hesitancy
we
have
encountered
has
been
expected
and
anticipated.
H
We've
been
dealing
with
vaccine
hesitancy
in
the
department
for
years.
It
was
well
before
covin,
and
so
we
we
sort
of
anticipated
some
of
it.
There
has
been
to
be
quite
honest,
some
vaccine
hesitancy,
that
we
did
not
anticipate
and
we
can't
readily
identify
reasons
for
that,
and
so
that's
why
the
market
research
piece
is
really
important
in
all
95
counties,
particularly
amongst
rural
conservatives
and
rural
white
men,
why
they
are
hesitant
and
trying
to
drill
down
on
that.
So
we
can
address
that
properly.
E
E
This
brief
is
what
I
didn't
see
in
this
presentation
and
budget
presentation
is
what
is
specifically
being
done
by
the
department
to
prepare
for
the
next
pandemic,
because,
while
we
like
to
you
know
pat
ourselves
on
the
back,
for
we
may
have
done
better
than
other
states
in
one
respect
or
another,
the
reality
is
people
died.
There
are
things
that
we
could
have
done
better.
I
think
we
all
agree
on
that.
E
H
Yes,
sir,
thank
you
for
that
question.
We
have
an
entire
division
of
emergency
preparedness
and
pandemic
preparedness
is
part
of
that
part
of
why
we
had
some
early
success
is
because
they
had
done
a
lot
of
good
preparations,
but,
as
you
very
aptly
mentioned,
we
can
always.
We
always
have
room
for
improvement.
H
That
is
very
robust
and
we
are
using
it
to
upgrade
our
systems,
we're
using
it
to
look
at
the
positions
that
we
have,
that
we
need,
where
any
gaps
that
we
found
was
there
equipment
that
we
could
have
used
more
quickly
were
there
systems
that
could
have
performed
better
and
those
are
the
things
that
we'll
be
using,
that
federal
funding
for
and
I'm
grateful
to
have
it.
It's
just
gonna,
take
some
some
effort
to
get
through
those
line.
Items.
E
F
I'm
just
wondering:
are
you
concerned
about
another
at
least
a
mini
surge
over
the
next
few
weeks,
since
you
know
we're
in
the
top
10
now
in
infections,
from
yesterday
in
the
country
and
overall
we're
the
sixth
most
infectious
state
in
the
entire
nation?
So
are
you
concerned
that
it's
gonna
get
bad
again.
H
Thank
you
for
the
question.
I
I'm
fairly
certain
it's
gonna
get
worse.
What
I
don't
know
is
how
high
the
next
surge
will
be.
We
are
already
starting
to
see.
We
saw
a
plateau
for
three
to
six
weeks
now,
we're
starting
to
see
it
tick
back
up
just
ever
so
slightly.
What
I
don't
know
is
if
that
will
be
a
little
blip
or
if
that
will
be
a
pretty
substantive
surge.
The
good
news
is
is
that
we
have
almost
20
percent
of
our
population,
that's
vaccinated.
H
F
Yeah
are:
are
you
reviewing
where
you
know
the
vaccine's
becoming
more
readily
available?
I
understand
that,
but
it
still
seems
like
we
have
a
lot
of
vaccine
in
areas
where
it's
not
being
used,
because
a
lot
of
my
constituents
are
having
to
drive
hours
and
they
and
they
do
it
readily
to
go,
get
a
vaccine
and
you're
putting
vaccines
in
communities
that,
if
they
don't
want
it,
I
mean
davidson
county
will
take
all
you
got.
You
know
we'll
be
more
than
happy
to
get
a
vaccine.
H
Yes,
sir,
of
course,
that's
been
a
shift
that
we've
been
making
over
the
last
week
or
two.
I
will
remind
you
that
our
allocation
methodology
heretofore
has
been
a
population-based
allocation,
and
how
do
I
say
this?
Delicately
local
leaders
have
held
us
to
every
single
dose
of
that
until
a
couple
of
weeks
ago.
They
wanted
every
single
dose
in
their
county,
and
if
I
were
in
that
role,
I
would
have
done
the
same
thing.
Now.
It's
a
little
bit
different,
because
uptake
is
very
different.
H
As
you
mentioned,
there's
some
rural
counties
where
literally
they're,
less
than
10
of
their
appointments,
are
filled.
A
couple
of
things
that
I
want
to
reassure
you
about.
One
is,
and
this
is
a
common,
a
common
thing
that
a
lot
of
people
believe
may
be
happening,
and
maybe
even
I
was
concerned
until
I
was
educated
about
it,
which
is
what
we're
not
doing,
is
continuing
to
send
every
week
to
those
places.
They
are
not
stockpiling
it.
It
is
not
building
up
there.
H
We
require
them
to
reconcile
their
inventory
every
24
hours
and
we
have
what
sort
of
their
weekly
set
limit
is
and
if
they're
not
exhausting,
that
they
don't
get
any
the
next
week.
What
that
does,
however,
do
is,
and
that's
just
been
in
the
last
couple
of
weeks,
what
it
does
is.
It
puts
more
in
the
bucket
that
we
have
to
dole
out,
and
so
we
can
no
longer
do
a
population
or,
let
me
say
we
can
no
longer
only
do
a
population
based
allocation
because
I
couldn't
send
it
to,
I
think,
maybe
48
counties.
H
This
week
there
were
48
counties
who
didn't
need
any
more
because
they
didn't
have
enough
uptake.
They
already
had
enough
on
the
shelf,
and
so
what
we're
starting
to
do
is
take
that
extra
allocation
and
divvy
it
up
amongst
the
places
that
do
have
higher
demand.
I
will
reassure
you
that
doctors,
wright
and
joe
hungier
call
every
day
asking
for
more
and
so
we're
able
to
do
that.
H
We're
particularly
able
to
send
out
more
pfizer
we're
now
in
this
weird
spot.
It's
maybe
too
much
detail.
I
apologize
we're
now
in
this
weird
spot,
where
a
lot
of
people
want
the
johnson
johnson
vaccine,
but
we
don't
have
enough
supply
of
that.
Yet
we
have
a
ton
of
pfizer
and
pfizer
keeps
sending
more
than
we
expect,
but
it
takes
a
it
takes
a
special
provider
to
do
the
pfizer
they
have
to
have
the
ultra
cold.
F
A
G
Thank
you
chairman
and
commissioner
congratulations
and
dr
mcdonald.
One
of
the
things
that
we
heard
over
and
over
and
over
throughout
covet
and
and
lingering
is
a
staff
shortage
with
clinical
bedside
nurses
etc,
and
I'm
keeping
hearing
I
just
heard
the
robust
cdc
grant
is
coming.
We
anticipate
there's
a
lot
of
cares,
act.
Money
that
is
coming
is
there
a
way
that
the
department
could
take
leadership
on
this
and
take
some
of
those
cares
like
money
and
develop
some
type
of
a
scholarship
program
that
maybe
it
assists
with
defraying
medical
education?
G
If,
if
maybe
a
nurse
agrees
to
do
five
years
at
the
bedside
in
a
hospital
or
an
underserved
population,
because
we
do
need
a
lot
of
our
educational
programs
are
geared
toward
independent
practice
or
geared
toward
you
know,
office
based
service,
but
I
think
that
what
we're
hearing
from
our
hospitals
is
a
constant
shortage
and
they're
paying
that
75
an
hour
etc.
But
I'd
love
to
hear
your
thoughts
on
that.
Thank
you,
mr
chairman.
H
Thank
you
for
that
question.
Certainly
staffing
and
staffing
allowances
and
incentives
and
recruitment,
and
all
of
the
things
related
to
bedside
staffing,
have
been
magnified
during
this.
We
always
knew
there
was
a
problem
before,
but
this
has
made
it
even
worse.
So
the
short
answer
to
your
question
is
yes,
absolutely
looking
at
that
money
for
a
lot
of
different
ways
is
that
loan
repayment
is
it
recruiting
incentives,
supporting
hospitals
with
signing
bonuses?
H
Is
it
a
re-look
at
what
they
are
allowed
to
do
and
they
were
allowed
to
do
other
things
during
the
pandemic
and
nothing
bad
happened,
and
you
know
what
happens
after
that?
So
all
of
those
comprehensive
approaches,
both
financially
as
well
as
from
a
policy
standpoint,
are
something
that
we're
trying
to
learn
from
and
go
forward.
A
E
I'm
honored,
mr
chairman,
now
I
just
wanted
to
publicly
thank
the
department
for
helping
out
last
weekend
I
got
to
volunteer
at
the
mass
vaccination
event
at
the
nikon
stadium
and
my
shift
started
at
5
00
a.m,
and
there
were
cars
lined
up
already
and
watching
that
take
place
and
having
access
to
all
those
vaccines
really
made
a
difference,
because
that
was
a
really
momentous
occasion
and
it
was
something
to
behold
and
I
was
honored
to
volunteer
at
that,
and
I
appreciate
the
department
working
with
davidson
county,
the
health
department
on
that.
Thank
you.
H
A
A
A
B
A
Okay,
seeing
none
we're
going
to
vote
on
house
joint
resolution;
three,
all
those
in
favor
say:
aye
opposed
eyes,
have
it
and
goes
on
to
calendar
and
rules
all
right
without
objection,
I'm
going
to
go
out
of
order
here
and
call
up
item
number
four
house
bill:
four:
five:
four
representative
hodges
new
york
house.
You
have
a
motion.
A
second.
B
A
B
All
right,
so
this
is
an
immunization
bill
in
in
what
it
is.
Is
we
have
soldiers,
when
they
pcs
from
a
different
base
in
a
different
state
to
fort
campbell?
Their
kids
are
already
out
of
school
for
a
prolonged
period
of
time
and
then,
when
they
get
here,
they
realize
that
they
still
can't
enroll
their
kids
in
school,
because
they
have
to
have
a
tennessee
immunization
record
that
their
texas,
immunization
record,
isn't
accepted
by
the
school
systems
here.
A
A
A
Okay,
seeing
none,
we
are
voting
on
house
bill
454,
all
those
in
favor
say
aye,
I'm
opposed
eyes.
Have
it
bill
goes
on
to
calendar
rules.
Thank
you
chairman.
Thank
you
committee.
I
appreciate
the
indulgence
of
the
committee
with
that
we
will
go
to
item
number
two
house
bill.
239,
chairman
ramsey,
recognize
you
have
a
motion,
a.
D
Second,
thank
you,
mr
chairman,
ladies
and
gentlemen.
This
this
bill
that
I
bring
to
you
today
is.
Is
it's
a
bill
to
frame
the
importance
of
a
an
issue
brought
to
me
from
a
family?
That's
pretty
close
to
all
of
us
too
many
times
is
obscured
by
general.
Publicity
of
illegal
drugs
lumped
under
criminal
code.
This.
D
This
concerns
corey
gunnells
a
43
year
old
man
that
has
a
family,
two
children,
a
wife
and
a
father,
doug
gunnels,
and
many
of
you
may
have
talked
to
him,
he's
our
tdot
liaison
and
iran.
I
won't
go
through
all
of
the
history
of
the
young
man,
but
in
2011
a
a
random
ct
scan
picked
up
neuroendocrine
carcinoma
in
him
and
which
was
removed
by
surgical
means
that
the
carcinoma
has
a
five-year
survival
rate
of
50,
so
it's
pretty
serious
type
of
cancer.
D
He
began
to
have
increased
growth
and
number
and
and
the
had
further
chemotherapy
that
lasted
three
or
four
months,
and
it
at
that
point
he
got
to
the
point
where
his
infection
susceptibility
was
so
high
that
that
they
stopped
chemotherapy
and
his
tumors
have
proliferated
in
his
extremities
calling
causing
pain.
The
situation
is,
is
oftentimes.
D
D
Illegally,
because
it's
not
the
possession
is
not
allowed
in
tennessee
his
blood
pressure,
oxygen
and
heart
rate,
improved
and
stabilized.
The
one
of
the
pain
and
cough
were
significantly
diminished,
the
tumor
that
caused
vocal
problems
shrank
by
half
and-
and
so
that's
the
first
time
in
three
years,
it
had
any
improvement.
What
we're
addressing
today
is
when
measures
cease
to
improve
or
even
jeopardize
the
remaining
quality
of
life.
D
A
D
Okay,
and
essentially
that
amendment
gives
the
right
to
possess
this
particular
type
of
oil
in
tennessee
not
to
make
or
buy
it.
It
requires
a
letter
from
a
patient's
primary
care,
physician
that
attests
to
the
diagnosis
of
a
life-threatening
cancer
by
rated
or
recognized
licensed
cancer
center
attests.
The
patient
received
conventional
methods
of
treatments
which
have
failed
and
is
signed
and
dated
by
the
physician
yearly
also
in
the
possession
has
to
be
the
proof
that
the
oil
was
purchased
lawfully
in
another
state.
I
I
want
to
thank
chairman
ramsey
for
bringing
us
a
situation
of
compassion
and
I
think
it
touches
all
of
our
hearts
from
the
story
that
he
has
described
and
I
want
to
support
his
bill
and
the
amendments
that
have
been
put
on
so
far,
but
certain
things
and
corrections
do
need
to
be
made,
and
that
is
that
he
describes
the
situation
of
a
of
a
tragedy
in
which
the
cancer
in
a
young
person
with
family
and
then
it
is
operated
on
and
then
it
has
returned.
So
it
is
metastatic
cancer.
I
The
bill
does
not
stage,
so
the
bill
only
says
that
it
is
life-threatening
cancer.
Let's
realize
that
all
cancers
when
they
develop
are
life-threatening,
certainly,
but
majority
of
them
can
be
treated
in
a
satisfactory
manner
thanks
to
advances
in
medicine
today
and
those
people
do
not
require
the
rso
or
other
means
of
that
kind.
In
this
situation,
as
I
said,
touching
our
nerves
of
compassion,
certainly
we
want
to
make
it
possible
for
this
person
and
others
in
the
same
situation,
to
have
this
remedy
available
to
them.
I
I
I
A
D
Amendment
certainly
the
source
makes
it
that
it
should
be
friendly,
but
the
actually
the
original
bill
had
two
of
these
issues
in
them
and
the
tennessee
medical
association
found
it
necessary
to
take
those
out.
So
I
I
would
not
want
to
infringe
on
the
suggestions
of
the
tennessee
medical
association.
D
D
Any,
oh,
I'm
sorry
chairman,
yes
originally,
and
I
think
maybe
the
portion
in
there
about
defining
metastatic
cancer
is,
is
something
that
they
did
not
address.
That
was
not
in
the
original
and,
and
that
should
be
adequate
to
add
to
the
bill,
and
I
wouldn't
think
would
change
it
sufficiently
or
significantly,
but
the
portion
about
the
opioids
they
did
remove
from
the
original
language
and
the
portion
about
the
physician
having
to
do
any
recommendation
or
any
counseling.
D
They
took
all
that
out.
We
had
before
we
had
that.
The
the
primary
care
physician
would
counsel
the
patient
on
the
consequences
of
using
any
unproven
materials
and,
and
they
took
that
out
because
they
didn't
want
any
responsibility
on
the
physician
in
this
situation,
so
so
that
one
portion
about
changing
the
metastatic
that
that's
totally
fine
with
me,
but
the
other
two
I
feel
like
would
be,
would
negate
any
any
feeling
of
tolerance
from
the
tennessee
medical
association.
I
Well,
thank
you.
The
reason
I
left
those
in
because
they
were
in
your
original
bill,
and
I
was
not
aware
that
they
had
been
taken
out
by
tma
and
it's
not
tms
bill.
It's
yours
bill
your
bill
and
it's
our
amendment
and
I
would
like
to
work
with
you.
I
think
definitely
including
the
metastatic
part,
is
very
important,
and
you
agree
with
that
sure.
Okay,
so,
mr
chairman
or
german
ramsey,
if
you
will
work
with
me,
let
us
go
ahead
and
repair
that
and
bring
it
back
and
make
it
the
right
thing.
I
D
And
and
I'll
I'll
certainly
bow
to
the
will
of
the
committee.
My
intention
and-
and
I
know
all
of
you
have
looked
on
the
the
information
today
and
see
that
this
bill
has
been
placed
in
in
general
sub
in
the
health
committee
in
the
senate
and
what
the
situation
is.
Is
there
at
least
four
bills
that
deal
with
cannabis
this
year,
and
the
indication
was
to
me
that
one
of
these
four
bills
is
intended
to
be
acted
on
by
the
senate.
D
One
of
them
has
already
been
defeated.
The
other
one
I
can't
think
came
up
today.
One
is
chairman
terry's
bill,
the
other
is
chairman
wendell's
bill
and
then
this
bill,
and
so
I
was
told
that
that
what
I
was
suggested
to
do
and-
and
let
me
ask
the
legal
analyst-
I
think
this
bill
goes
to
criminal
justice
next.
D
D
It
may
not
pass
there,
but
my
instructions
were
to
take
it
as
far
as
we
could
and
then
stop
the
bill
before
it
goes
to
calendar
and
rules
in
in
the
eventuality
that
it
is
a
vehicle
for
the
senate
to
act,
and
at
that
time
it
will
be
taken
off
general
sub
in
the
senate.
So
I'll
bow
to
the
will
of
the
committee.
G
Thank
you,
mr
chairman.
I
do
have
one
question
and
this
is
going
to
be
directed
toward
legal
and
both
of
the
amendments
that
were
brought
both
by
the
bill
sponsor
and
by
dr
kumar.
They
reference
that
this
will
be
a
raided
or
recognized
licensed
cancer
center.
What
is
the
definition
of
that
encode?
Is
that
a
oncology
practice
is
that
a
treatment
centers
of
america?
What
is
the
definition
of
a
recognized
licensed
cancer
center?
Thank
you,
mr
chairman.
I
All
right,
oh
well,
thank
you
again
considering
the
nature
of
the
american,
considering
our
relationship
with
chairman
ramsey,
I'm
comfortable,
and
my
understanding
is
that
he
says
that
if
the
bill
passes
this
committee
on
the
way
to
criminal,
he
will
amend
it
so
that
it
is
satisfactory
that
the
word
metastatic
is
added
and
I'll
be
happy
to
work
with
him.
With
that
premise,
I
would
ask
for
the
question.
A
D
B
Leader
gain,
I
guess
the
posture
is
that
we
are
currently
on
the
amendment
by
dr
kumar
that
amendment
would
amend
only
a
portion
of
the
bill.
We
currently
have
a
bill
as
amended
by
4132,
that
the
committee
previously
took
action
on,
and
so
it
would
either
be
that
this
amendment
goes
on
now,
or
they
do
another
amendment
later
or
would
have
to
override
it
with
a
new
amendment
that
makes
the
bill.
E
A
A
A
J
A
J
Who
has
been
diagnosed
with
quadriplegia
as
a
result
of
an
incident
in
the
service,
the
united
states
armed
forces
and
it
simply
provides
with
cannabis
oil,
not
smoking,
no
other
method
except
cannabis,
oil.
It's
a
very
simple
bill,
it's
a
very
narrow
bill,
and
it
applies
to
only
one
example
and
that's
a
quadriplegic
who
is
a
quadriplegic
as
a
result
of
service
in
the
united
states,
armed
forces
and
the
quadriplegic
was
acquired,
not
acquired
was
inflicted
as
a
result
of
a
service
connection.
A
Okay,
any
questions
on
the
amendment:
okay,
seeing
none.
We
are
voting
on
amendment
four
five,
six,
eight,
all
those
in
favor
say
aye
opposed
eyes.
Have
it
okay.
We
are
back
on
the
bill
as
amended,
and
we
have
another
amendment
to
consider
on
this
amendment.
Five,
five,
one,
seven
chairman
kumar,
are
you
recognized.
I
I
I
I
I
In
addition,
I
wanted
to
add
that,
because
fda
approved
remedy
for
these
muscle
spasms
is
available.
The
physician
who
gives
the
letter
saying
that
this
that
this
patient
has
quadriplegia
or
periplegia
should
also
add
that
the
legal
fda
approved
remedy
has
been
tried.
I
think
that
should
be,
if
you're
going
to
proceed
in
a
systematic
manner.
That
should
be
a
part
of
the
letter,
and
that's
really
my
amendment
and
move
to
adopt.
J
However,
the
tennessee
medical
association-
I
can't
speak
for
them,
but
they
want
no
part
of
medical
marijuana
and
this
brings
them
back
into
the
mix
and
it's
my
impression
and
we
can
talk
to
them
and
find
out
what
their
position
is.
But
we
drew
them
out
of
this
bill
because
they
requested
to
not
be
a
part
of
the
bill,
and
this
puts
them
back
in
it.
J
But
I'm
willing
to
take
the
amendment
I'm
going
to
go
forward
with
it,
but
I
think
we're
going
to
have
an
issue
from
the
medical
association
and
I'm
not
here
to
criticize
them,
but
at
some
point
tennessee
is
going
to
have
to
deal
with
this
issue
in
a
straightforward
way.
It's
today,
maybe
maybe
not,
but
at
some
point
the
voters
will
demand
of
this
body
to
do
something.
I
Thank
you
chairman,
chairman
wendell.
I
am
not
a
member
of
the
tma,
I
am
not
a
member
of
tma
and
I
am
not
in
a
position
here
to
represent
or
support
tma.
We
lea.
We
deal
with
the
merits
of
the
issue
and
I
think
your
bill
has
merit.
In
fact,
I
have
not
taken
anything
away
from
it.
I
have
added
to
it
and
in
that
spirit
I
think
I
don't
see
why
this
is
a
poison
pill.
I
didn't
understand
that.
J
Well,
it's
not
to
me,
I
I
think
you're
you're,
chairman
you're,
recognized,
I'm
sorry.
I
think
your
rationale
is
accurate.
I
don't
disagree
with
you.
I
don't
think
your
colleagues
that
are
members
of
the
medical
community
in
primary
care
offices
throughout
tennessee,
for
whatever
reason-
and
I
can't
speak
for
them,
but
through
their
organization,
they
want
no
part
of
medical
marijuana
and
again,
I'm
not
here
to
criticize
that
sure,
but
that's
my
impression,
but
I'm
willing
to
take
the
amendment
and
let's
move
forward
and
I'll
take
whatever
consequences.
G
And
again,
thank
you
chairman.
This
is
directed
toward
legal
because
in
healthcare
there
are
different
definitions
that
sometimes
don't
match
up
with.
What's
in
the
green
book,
so
could
you
find
us-
and
you
don't
have
to
answer
it
immediately,
but
what's
the
definition
of
paraplegia
in
the
green
books,
as
opposed
to
and
I'll
take
a
a
a
definition
from
our
gentleman
in
the
medical
field?
G
What's
the
paraplegia
definition,
because
in
a
different
capacity
in
life,
I
had
an
awareness
that
hemiplegia,
which
is
a
partial
paralysis,
was
defined
differently
in
code
than
it
is
in
medical
practice,
and
I
want
to
make
sure
that
we're
aware
of
what
we're
about
to
put
into
law
if
we're
supportive
of
this
bill
as
defining
paraplegia
and
quadriplegia.
Thank
you.
B
Well,
I
like
to
offer
my
take
on
what
it
is:
quadriplegia
is
c7
and
up
and
below
it,
you
break
your
neck,
your
quadriplegic
or
neurologically
from
that
and
then
down
below
c7.
All
the
way
to
the
t's
are
considered
paraplegic
when
you
break
your
back.
So
it's
between
your
neck
and
your
back,
not
only
the
bones
but
neurologically
what
they
affect
from
c7
up
and
then
down.
So
that's
what
I've
understood
over
the
past
30
years
and
I
think
it's
probably
still
accurate.
B
B
Is
it
something
that
is
available
at
the
cannabinoid.com,
where
how
does
one
get
a
cannabinoid,
because
from
my
where
I
sit
the
if
we're
gonna
make
it
people
who
are
seeking
assistance
and
relief
to
us
to
a
problem
if
we're
putting
a
hurdle
in
front
of
them?
I'm
not
really
interested
in
doing
that,
but
I
would
like
to
know
what
it
is.
How
does
one
get
one.
A
And
I
may
represent
recognize
the
chairman
there.
Currently,
there
are
medications
that
are
approved
by
the
fda
syndros,
which
is
a
liquid
form
of
thc
which
be
a
cannabinoid
marinol,
which
is
a
pill
form
and
then
there's
epidiolex,
which
is
cbd
essentially,
and
it's
an
it's
a
cannabinoids.
So
I
believe
that
the
bill
will
be
referencing.
Those
medications.
B
B
I
On
a
basic
level,
there
are
two
main
components
in
marijuana:
there
are
many
cannabinoids
or
cannabis
related
compounds
in
marijuana,
but
thc
is
the
main
one.
Thc
is
what
causes
people
high?
It
is
the
psychoactive
substance
cbd.
I
call
it
thc,
I
call
it.
The
high
causer
it
causes
high
cbd
is
the
other
component.
That
is
more
of
a
relaxation
thing.
It
has
very
little
to
very
little
thc
less
than
one
percent,
although
they
can
cheat
so
cbd
is
basically
a
relaxing
thing.
It's
almost
like
valium,
that's
why
it
is
useful
in
childhood,
epilepsy.
I
I
If
you,
if
you
google,
just
say
maryland,
marinol
walgreens,
it
tells
you
it's
about
a
dollar
or
two
a
pill.
So
cannabinoids
are
synthetic
thc
or
synthetic
marijuana
that
is
fda
approved
for
the
conditions
that
are
listed
and
they
are
available
on
prescription
from
a
physician
because
they
are
scheduled.
Two
and
three.
B
A
Thank
you.
Oh
let's
get
some
clarification
on
the
amendment
here,
real
quick,
so
part
a
a
test
if
we're
adding
paraplegia
to
the
definition
that
came
out
of
subcommittee
on
on
the
on
the
bill.
Is
that
correct?
Okay,
and
is
that
partial
temporary
it
just?
It
does
not
say
one
way
or
the
other
true?
It
does
not.
Okay
part
b
says
that
affirms
that
the
physician
has
discussed
with
the
patient
the
potential
risk
or
benefits
of
use
of
cannabis
cannabis
oil
to
alleviate
the
patient's
symptoms.
I
My
amendment
that
is
taken
out
because
a
physician
is
not
allowed
legally
to
counsel
people
about
marijuana,
because
then
they
are
discussing
benefits
and
so
on
and
marijuana
is
illegal
and
the
license
to
prescribe
those
substances
is
given
by
the
dea.
So
that's
a
federal
matter.
So
yes,
it
should
not
be
included.