►
Description
House health Subcommittee - February 22, 2022 - House Hearing Room 2
A
A
Thank
you,
ms
clerk,
do
we
have
any
personal
orders
this
morning
or
this
afternoon?
If
not,
I
would
say,
welcome
I
I
noticed
the
t-shirts
and
I
had
to
get
up
close
to
read
them.
I
think
we
have
our
food
truck
representatives
here
today
welcome
and
several
other
folks,
but
I
hope
you
brought
some
some
samples
we'll
meet
you
on
the
hall.
So
if
there
are
no
personal
orders,
we
will
proceed
with
today's
calendar.
We
have
first
house
bill
2120
by
chairman
curcio.
You
are
recognized,
sir.
C
A
C
C
You
know
it's
hard
to
imagine
a
more
free
market
opportunity
than
a
u.s
citizen
with
an
idea,
an
opportunity,
a
skill
set
to
say
you
know
what
I'm
gonna
take
this
show
on
the
road
and
and
try
to
make
a
living
at
it,
and
that's
that's
a
food
truck
right.
You
know
many
of
our
most
favorite
restaurants
were
started
out
in
the
back
of
somebody's
house
or
in
a
food
truck
or
at
a
fair
or
at
a
at
a
flea
market,
and
today,
they're
they're,
thriving
business
owners.
C
My
grandfather
was
first
generation
italian
american
came
to
new
york
city
got
his
start
in
the
restaurant
business,
my
father
and
I
my
wife,
my
father
and
I
all
three
of
us
owned
a
restaurant
in
the
city
of
dixon.
Where
I
live
for
a
number
of
years
and
what
we
always
said
was
you
know
the
thing
about
restaurants?
C
Is
you
just
need
more
of
them
together
in
a
cluster
and
concentrate
to
help
that
that
tide
raise
all
of
those
boats,
and
so
many
of
you
may
have
been
surprised
to
find
out
when
I
came
and
talked
to
you
about
this
bill
that
food
trucks
have
actually
been
subject
to
a
patchwork
of
regulations
across
the
state
and
in
some
jurisdictions,
or
even
just
outright
banned
or
outlawed,
even
on
private
property,
which
is
which
is
ridiculous
in
my
opinion.
So
what
my
bill
would
do
is
seek
to
write
that
correct
that
ill.
C
C
I
don't
know
if
you've
seen
some
of
these
these
rigs,
but
they
can
cost
upwards
of
150
200
000.
So
these
tennessee
taxpayers
are
paying
taxes
to
the
state
when
they
purchase
that
that
vehicle
they
also
pay
sales
tax.
So
wherever
they're
registered
as
a
business,
if
they're
registered
in
dixon
county
or
cheatham
county
or
or
clay
county
they're
going
to
pay
sales
tax
to
that
county,
where
they're
registered,
they
also
must
submit
to
the
fire
marshal's
inspection
they
also
submit
to
the
health
department.
Just
like
a
restaurant
does
so
they
get
a
score.
C
You
know
just
like
you
were
accustomed
to
seeing
in
a
restaurant
and
that's
an
annual
inspection
plus
they
have
random
inspections
as
well.
There
are
some
questions
about
public.
You
know
these
being
a
public
nuisance,
which
I
certainly
don't
see
them
as
that,
but
I
just
want
to
draw
your
attention
to
some
of
the
language
and
the
amendment
that
would
address
that.
C
It
says
here:
a
mobile
food
truck
shall
be
maintained
in
good,
operating
order
as
applicable,
provide
a
marked
waste
receptacle
for
customers
and
request
customers
to
use
the
receptacle.
So
they
can't
just
you
know,
wonder
where
the
trash
goes.
They've
got
to
have
a
plan
for
that
collect,
remove
and
dispose
of
all
refuse
within
25
feet
of
the
mobile
food
units
operating
area
at
the
conclusion
of
service
submit
and
pass
health
inspections
required.
Pursuant
to
this
part
and
annually
submit
and
pass
one
local
fire
inspection
anywhere
in
the
state.
C
C
The
answer
is
no,
and
let
me
talk
about
why
so
it
says
the
the
local
authority
may
enforce
health
and
fire
inspections
required
pursuant
to
subject
subdivision
b,
four
and
five
enforce
generally
applicable
laws
regarding
municipal
offenses,
including
offenses,
against
the
peace
and
quiet,
trespassing
and
interference
with
traffic.
I
think
that's
very
important.
You
know
a
lot
of
people
say
well
they're,
just
going
to
set
up
a
food
truck
down
main
street
in
dixon
and
block
two
parking
spaces
and
start
selling
hamburgers
in
front
of
a
brick
and
mortar
restaurant.
C
Absolutely
not
if
they
do
that
cops
need
to
come
and
run
them
off
they'll
be
they
would
be
in
violation
of
not
only
local
municipality
orders
but
blocking
traffic
blocking
the
free
flow
of
traffic,
and
then
it
says
a
local
authority
may
regulate,
restrict
or
prohibit
the
operation
of
a
mobile
food
unit
in
residential
zoning
districts.
So
again
we
are
not
turning
neighborhoods
into
restaurant.
C
If
I
want
the
xander's
pizza
truck
to
come
up
and
make
pizza
for
all
the
kids,
they
can
do
that
on
my
property
because
I've
invited
them
there,
but
this
bill
would
limit
that
to
an
eight
hour
period
and
if,
if
at
any
time,
I'm
violating
a
noise
ordinance
or
doing
anything
else,
that's
in
violation
of
the
peace
and
quiet
of
that
neighborhood.
The
city
absolutely
has
the
the
authority,
and
I
would
say
the
obligation
to
shut
me
down
or
to
come
by
and
tell
me.
C
If
it
moves
tax
it
if
it
keeps
moving,
regulate
it
and
if
it
stops
moving
subsidize
it,
it's
exactly
what's
happening
with
food
trucks
across
the
state.
All
we're
seeking
to
do
is
level
the
playing
field
so
that
whatever
jurisdiction
you're
in
you
know
what
the
rules
of
engagement
are
and
you
can
operate
safely
and
effectively
in
a
manner
that
is
compliant
again.
A
B
C
Okay,
no
I'm
glad
you
I'm
glad
you
asked
because
that's
a
question
I
keep
getting
over
and
over
again,
so
this
would
in
in
the
bill.
It
says
that
municipalities
may
enforce
generally
applicable
local
laws
regarding
municipal
offenses,
including
offenses,
against
the
peace
and
quiet
trespassing
interference
with
traffic.
It
also
says
that
they
can
regulate,
restrict
or
prohibit
the
operation
of
a
mobile
food
truck
in
a
residential
zoning
area.
So
what
this
bill
would
absolutely
not
allow
is
for.
I
live.
C
C
What
it
would
allow
me
to
do,
though,
is
for
when
my
youngest
turns
seven
here
in
a
couple
of
weeks,
invite
a
pizza
truck
into
our
driveway
to
serve
pizza
to
all
the
children
that
come
to
that
party,
their
parents
so
on
and
so
forth.
We
would
probably
buy
the
truck
out.
In
other
words,
I
would
just
pay
the
pizza
owner
at
the
end
of
the
deal,
because
I
don't
want
to
charge
the
kids
for
coming.
C
But
but
you
know,
although
it's
not
a
bad
idea
but
but
but
but
that's
where
you
could
have
them
on
your
private
property
and
they're
they're
able
to
serve.
But
you
can't
do
it
for
more
than
an
eight-hour
period
within
a
24-hour
period
and
it's
got
to
be
for
a
social
gathering
or
or
a
party.
Something
like
that.
Okay,.
D
Thank
you
and
and
chairman.
We
talked
a
great
deal
about
this
and,
and
I
think
the
world
of
you-
you
know
what's
coming
next
and
and
I
also
love
food
trucks
and
exactly
what
you're
saying
I
have
personally
done
on
numerous
occasions
every
year
for
halloween,
we
we
close
our
street
and
we
get
a
bunch
of
food
trucks
that
come
in.
D
I
literally
got
on
social
media,
so
I
could
follow
a
local
company
here
that
did
tater
tots
and
grilled
cheese
and
and
so
I'm
a
I'm
a
big
fan
of
of
food
trucks.
But
as
I
as
I
look
through
this,
you
know
there
is
nothing
more
local
than
local
zoning
requirements
and
we
create
in
every
different
municipality,
where
we
allow
businesses
to
operate
and
doing
away
with
the
municipality.
D
They
want
to
know
that
when
a
customer
comes
to
their
facility
that
they
are
getting
the
best
possible
product
out
there
and
part
of
that
is
through
through
supervision
from
from
a
municipality,
and
if
you
remove
the
ability
it
just
gives
me
great
concern
and
and
furthermore
having
somebody
who's
invested
a
great
deal
of
money
in
a
brick
and
mortar
facility
to
be
able
to
have
their
neighbor
lease
their
space
to
somebody
else
that
can
get
can
undercut
them.
That
again,
doesn't
doesn't
pay
any
of
the
infrastructure
costs.
D
I
think
is
a
problem
and-
and
that's
why
I
got
phone
calls
from
several
people
in
my
community,
and
we
had
a
representative
who
represents
gatlinburg
call
around.
He
had
great
concern
with
this,
and
so,
while
I
appreciate
the
the
thought
I
think
it,
it
might
need
a
little
tweaking
for
me
to
be
able
to
support
it.
Chairman.
C
You,
mr
chairman,
I
do
want
to
just
respond
to
a
couple
of
those
things
because
I've
been
asked
about.
You
know
the
parking
requirements
and
what
happens
if
the
cops
have
to
be
called,
and
the
example
that
was
given
to
me,
just
you
know,
locally
being
from
a
small
community,
was
what
if
walmart
invites
so
many
food
trucks
to
operate
in
their
parking
lot,
that
it
then
blocks
their
parking.
So
they
don't
have
the
required
number
of
parking
and
we
have
to
send
the
cops
out
there.
C
They
pay
a
whole
lot
of
property
taxes
right
so
they're,
the
ones
that
are
in
control
of
their
parking
lot
and
if
they
did
something
to
block
their
parking
lot,
the
city's
got
a
problem
with
that
property
owner
say:
look,
you
didn't
live
up
to
your
end
of
the
bargain.
We
said
if
you
were
going
to
build
this
big
box
store
here,
you
had
to
have
500
parking
spaces
and
because
you've
invited
these
food
trucks
in
you've
only
got
200
parking
spaces.
C
The
other
thing
that
I've
heard
is
is
this
argument
about
a
brick
and
mortar
again
I
come
from
a
multi-generational
restaurant
family
when
we
had
our
restaurant
in
downtown
dixon.
What
we
needed
was
50
more
restaurants,
all
around
us
and
I
didn't
care
if
they
had
the
exact
same
menu
as
me,
we
needed
more
traffic
food
trucks,
absolutely
bring
traffic
in
areas
where
there's
already
an
attraction.
C
So
the
example
that
I
would
give
is
that
when
I
buy
a
taco
from
a
food
truck
vendor,
it
hasn't
replaced
me
buying
a
hamburger
and
a
beer
at
the
sports
bar.
That's
brick
and
mortar
number,
one
that
food
truck
operator
doesn't
have
a
liquor
license.
They
don't
have
a
dining
room.
I
can't
watch
an
ole,
miss
game
from
that
food
truck
operator.
I'm
gonna
have
to
go
inside
a
restaurant
and
do
that.
C
If
that's
what
I
want
to
do
the
other
thing
that
we
know
we've
seen
studies
that
prove
this
is
that
when
I
then
go
to
that
area,
and
I
buy
that
item
from
that
food
truck
owner,
I
then
walk
around
and
I'm
going
to
spend
a
lot
of
other
money
at
retail
stores,
because
it
keeps
me
in
that
downtown
area
longer
it
makes
it
makes
them
more
sticky
to
me
because
we're
going
down
there
for
an
event,
the
kids
may
get
a
snow
cone.
I
may
get
a
taco.
C
My
wife
may
want
to
go
into
the
spa
and
get
a
you
know
a
massage
or
a
nail
treatment
while
we're
you
know,
shopping
up
and
down
main
street.
So
these
absolutely
help
drive
not
only
the
sales
tax
that
they
generate,
but
also
help
pay
for
all
of
the
infrastructure
around
them
by
patronizing
those
other
businesses,
a
traditional,
brick
and
mortar.
Or
what
have
you?
And
so
I
have
gotten
that
question
a
lot
and
again
I
I
could
absolutely
sympathize
with
that.
C
As
a
person
who
owned
a
restaurant
I'll
also
say
this,
I've
had
officials,
name
restaurateurs
by
name
and
say
well,
you're
going
to
hurt
so
and
so
they've
got
their
life
savings
wrapped
up
into
their
brick
and
mortar
business.
So
then
I'll
go
to
that
restaurant
owner
and
I'll
say
I'm
so
sorry.
I
hope
you
haven't
taken
offense
to
my
legislation,
because
I
don't
want
to
hurt
you
and
they'll
say.
Why
was
that
city
official
using
my
name?
I'm
not
against
this
at
all.
In
fact,
I'd
love
to
be
able
to
operate
a
food
truck.
C
I
would
love
if
there
were
food
trucks
in
our
area.
Please
tell
them
to
stop
using
my
name,
so
I
think
if
you
actually
go
to
those
folks,
you'll
find
that
they
have
a
completely
different
view
of
this,
that
that
more
density
brings
more
people
brings
more
economic
activity,
and
but
I
do
appreciate
you,
you
bringing
those
things
up
because
they
are
common
things
that
I'm
hearing.
I
know
members
of
the
committee
are
hearing,
and
so
I
appreciate
the
opportunity
to
be
able
to
address
them.
Representative.
D
Freeman
yeah
thanks
again,
that
was
that
was
low
down
bringing
up
ole
miss
to
this
listen,
I'm
and
I'll,
say
it
say
it
again.
I
I'm
a
I'm
a
huge
fan
of
food
trucks
and
I
I
think
that
there
is
absolutely
a
place
for
for
them
and
and
for
those
small
businesses
to
operate.
I
just
believe
that
a
municipality
should
have
the
ability
to
to
control
their
own
destiny
there
and
some
of
it
just
removing
that
ability
if
it
was
purely
that
they
can't
prohibit
I'd,
be
I'd,
be
on
board.
D
D
A
C
Thank
you.
I
don't
want
to
bore
the
committee,
but
I
just
want
to
remind
everybody.
This
does
allow
cities
to
enforce
their
already.
You
know
their
codes
that
are
already
on
the
books
as
far
as
public
nuisance
and
and
ordinances
that
nature,
it
also
would
not
allow
them
to
sell
in
a
residential
area.
So
I
just
want
to
want
to
clarify
that.
C
So,
if,
if
a
property's
owned
commercially,
then
that's
that's
what
we're
talking
about
where
if
I
want
to
make
a
deal
with
the
map,
co
owner
and
the
map,
co-owner
is
okay
with
me
sitting
in
their
parking
lot
on
a
saturday,
and
the
guy
says,
give
me
six
percent
of
your
sales
or
just
pay
me
a
flat,
500
bucks,
and
you
can
hang
out
there
for
the
day.
That's
what
we're
talking
about.
You
know.
C
I
don't
think
the
city
needs
to
add
an
extra
layer
of
taxation
and
regulation
on
time,
and
one
thing
that
I
neglected
to
say
too
is
that
if
cities
want
to
levy
a
restaurant
tax,
that's
what
I
keep
hearing
is
well
what
about
the
property
tax?
Well,
that's
that's
for
property
owners.
If
cities
want
to
levy
a
restaurant
tax
by
all
means,
you
know
good
luck
getting
that
pass
through
your
your
city,
council
or
your
or
your
metro
council.
C
I
think
I
think
you'd
have
a
pretty
big
uprising
on
your
hands
and
so
property
owners
pay
property
taxes.
People
who
sell
things
pay
sales
tax
people
who
purchase
things
like
150
000
food
trucks
pay
sales
tax
when
they,
when
they
purchase
those
trucks,
so
I
just
think
they're
taxed
enough.
I
think
we
need
to
create
a
level
playing
field
across
the
state
and
allow
the
free
market
to
function.
A
C
Thank
you,
mr
chairman,
great
question.
I'm
glad
you
asked
that
so
I
guess
in
in
theory
you
could
be
a
sole
proprietor.
So
if
you
could
you
could
open
a
business
under
your
name
under
your
social
security
number
now
you
would
still
have
to
submit
sales
tax.
In
order
to
do
that,
I
would
I
would
counsel
you,
though,
if
you
ask
me
advice
I
would
say
don't
do
that
because
you
have
no
liability
shield.
C
If
someone
wanted
to
sue
you
and
in
your
capacity
as
the
as
the
business
owner
the
person
responsible
there,
you
have
no
liability
shield.
So
often
what
every
small
business
owner
will
do
is
they'll
form
an
llc.
So
wherever
you,
wherever
you,
formulate
that
llc
you're
going
to
pay
taxes
as
an
llc
and
the
sales
tax
revenue
that
you
generate
will
be
credited
to
the
county
where
you're,
where
you're
registered
as
a
business
owner
now
they
could
be
different.
Though
you
one
food
truck,
may
have
an
s.
Corp
one
may
operate
under
an
llc.
C
A
B
B
C
That's
a
city
park,
I
think-
and
so
if,
if
the
city
of
nashville
wanted
to
keep
every
single
one
of
these
regulations
in
place-
and
I
anticipate
that
they
would-
I
don't
know
why
they
would
you
know,
scrap
them
after
this
bill
passes,
they
would
be
able
to
issue
permits
on
their
own
property
and
I
think,
that's
appropriate.
What
this
bill
seeks
to
do
is
respect
everybody's
private
property
rights,
so
property
that
the
city
owns.
C
You
know
they
can
make
that
permit
as
high
and
as
rigorous
as
they
want
to.
If
they're
trying
to
restrict
food
trucks,
that's
probably
what
they'll
do
if
they,
if
they
generally
want
to
be
more
food
truck
friendly
they'll
either
have
you
know
they'll
have
little
to
no
regulation
or
a
very
low
permit,
but
it
would
actually
absolutely
preserve
their
ability
to
do
that.
B
B
When
does
that
become
chronic,
I
guess
is
if
they
have
an
event
and
it's
a
personal
property,
and
maybe
I
don't
it
it's
residential,
but
it's
in
a
prime
location
to
where
they're
having
an
event
or
calling
an
event.
Maybe
there's
a
week-long
festival.
I
don't
know
but
they're
having
an
event
every
day
when
does
that
become
chronic?
When
does
that?
When
does
that
trigger
of
okay
you're,
not
you're,
no
longer
doing
this
for
a
kid's
birthday
party.
C
Chairman
excellent
question-
and
this
is
something
you
and
I
talked
about
in
my
office
not
long
ago,
but
that
would
be
up
to
the
local
municipalities,
other
ordinances.
So
again,
I
would
draw
your
attention
to
part
b,
enforce
generally
applicable
laws
regarding
municipal
offenses,
including
offenses,
against
the
peace
and
quiet,
trespassing
and
interference
with
traffic,
so
specifically
there
to
peace
and
quiet.
C
If
I
hosted
it's,
my
understanding
that
I
can
have
a
party
at
my
house
and
I
can
even
have
live
music
at
my
house
under
my
local
city's
ordinances,
but
it's
got
to
stop
at
a
certain
time,
and
so
everybody
understands
that
your
cousin
gets
married
and
you
want
to
let
her
have
a
party
in
your
backyard.
That's
that's
well-worn
ground
right,
but
what
we
also
know
is
that
if
you're
doing
that
in
a
residential
neighborhood
on
your
own
property,
instead
of
renting
out
an
event
center,
you've
got
to
play
by
the
city's
rules.
C
C
Those
are
going
to
be
at
the
local
level,
so
I
can't
speak
specifically
to
what
would
be
you
know
in
your
neighborhood.
I
know
in
my
neighborhood
we've
we've
had
to
look
at
that.
I
live
in
a
family
home
we've
hosted,
including
my
parents,
back
in
the
60s
long
before
I
lived
at
my
house,
obviously
because
they
weren't
married,
yet
my
parents
wedding,
was
there.
We've
had,
I
think,
15
family
weddings
at
our
house.
C
C
You
know
we
called
our
neighbors
say:
hey
we're
having
a
party
come
over
if
you'd,
like
always
a
good,
you
know
practice
right
to
invite
your
neighbors
to
your
party,
but
but
if
that
were
something
that
we
were
doing
four
or
five
days
out
of
a
week
or
every
single
weekend
out
of
a
month,
the
city
would
absolutely
shut
me
down.
I
mean
that's
just
that's
really
designed
to
be
a
one-off
kind
of
thing
and
again
the
the
local
municipal
ordinances
would
speak
to
that.
B
C
A
Further
comments
or
questions
about
the
bill
as
amended,
if
not
before
we
take
the
vote
here.
Let
me
let
me
just
say
that
we'll
be
sending
this
to
the
full
committee.
The
vote
vote
on
this
issues
to
the
full
committee,
all
those
in
favor
say
aye,
any
opposition,
no
call
the
roll.
Madam
clerk,
a
vote
yes
will
be
to
send
this
bill
as
amended
to
full
committee.
A
B
A
Thank
you,
mr
chair
chairman,
before
we
go
any
further,
let
me
take
just
a
moment
here
to
congratulate
a
group
of
folks.
This
is
tennessee
hospital
association
day
on
the
hill.
I
want
to
congratulate
all
of
you
that
are
here
today
on
a
job
well
done.
Over
the
last
couple
of
years,
we've
depended
heavily
on
you
to
maintain
the
health
status
of
our
state.
We
have
with
us
today.
Hospital
leaders
from
across
the
state
is
anybody
here
from
blunt
memorial.
A
I
don't
see
a
hand,
but
we
we
certainly
welcome
all
of
you.
We
appreciate
the
effort
that
you
make
to
be
here.
Nobody
can
put
a
price
on
volunteerism
and
I
know
it's
hard
to
come
up
here
and
visit
with
us,
but
I
appreciate
the
effort
so
we'll
move
on
to
item
two
house
bill
2537
by
leader,
gantt
you're,
recognized,
have
proper
motion
and
second.
E
What
this
legislation
is.
It
somewhat
mirrors
a
piece
of
legislation
that
I
brought
to
you
two
weeks
ago
about
federally
qualified
centers
and
I've.
I've
got
an
amendment
that's
going
to
be
coming
before
we
go
to
full.
If
y'all,
let
me
get
this
out
and
get
it
to
full.
There's
an
amendment
that's
going
to
come
in
and
and
strike
out
the
language
that
deals
with
the
federally
qualified
health
centers,
because
obviously,
we've
already
passed
that
so
this
legislation
would
override
that.
E
So
the
amendment
that
I'll
bring
in
full
we'll
take
care
of
that,
and-
and
I
want
to
be
very
clear-
this
is
my
legislation,
not
tma,
not
the
nurses,
association
or
anybody
else.
This
is
the
legislation
that
I'm
bringing.
So
I
think
there
was
some
confusion
on
that
with
some
of
the
talk
that's
been
going
on,
so
I
want
to
make
that
perfectly
clear.
E
So
what
this
legislation
does
is
it
takes
your
private
practice
and
allows
your
physician
assistance
and
your
nurse
practitioners
to
be
able
to
do
the
same
thing
by
remotely
working
with
their
physician,
but
doing
it
from
a
virtually
elect
electronic
virtual
format,
and
in
this
legislation
it
would
require
two
out
of
the
whole
year.
It
would
require
two
on-site
visits
by
a
collaborating.
A
A
A
We
do
need
a
motion
and
a
second
on
that
amendments
have
proper
motions
taken
on
the
amendment.
All
those
in
favor
of
the
amendment
being
placed
on
the
bill
say
aye
any
opposition,
we're
on
the
bill
as
amended,
and
I
think
you
have
discussed
the
part
of
it
that
you
needed
to
did.
Did
you
have
requests
for
testimony.
A
A
Okay,
so
since
you
don't,
you
haven't
requested
a
testimony,
we
will
will
take
questions
here
and
then
we
have
kathleen.
Murphy
has
requested
that
she
be
allowed
to
address
the
the
bill.
Do
you
want
her
to
go
ahead
and
give
testimony?
I'm
sorry,
mr
chairman,
I
didn't
hear
you
okay,
since,
since
you
have
not
requested
any
testimony,
we
have
had
a
request
from
kathleen
murphy
to
the
nurses
association
to
give
testimony
on
the
bill.
Would
you
prefer
to
have
that
before
or
after
we
have
questions
from
the
committee.
E
A
So
we're
we're
on
the
bill
as
amended
and
what
we'll
do
is
go
out
of
session,
recognize
kathleen
murphy
and
you
can
come
up
and
and
have
give
us
your
testimony
and
we'll
the
three
minutes
and
we'll
stand
for
questions
and
answers
after
that,
so
we're
out
of
session.
No,
no
objections.
We're
going
out
of
session.
F
Thank
you,
chairman,
kathleen
murphy,
with
the
tennessee
nurses
association.
We
have
been
talking
with
representative
gant
up
until
walking
into
the
meeting
today,
and
so
I
appreciate
still
being
allowed
to
hurt,
be
heard.
I
think
representative
gant
and
I
will
be
able
to
work
through
some
of
the
issues
on
this
legislation.
F
Based
on
that
setting,
and
so
that's
our
concern
here
is
where,
if
you
all
have
already
decided
that
federally
qualified
health
centers
should
not
have
to
have
any
on-site
reviews.
If
the
community
health
center
should
not
have
any
on-site
reviews,
then
why
are
we
setting
up
this
kind
of
different
tier
for
advanced
practice,
registered
nurses
and
other
settings?
F
And
so
that's
where
we'd
really
like
to
get
that
worked
out
and
smoothed
out
prior
to
this
moving
forward
but
again
willing
to
continue
to
work
with
with
leader
gantt
to
to
try
to
make
sure
that
we're
all
on
the
same
page?
Here
I
just
wanted
to
make
sure
that
we
expressed
that
view
and
I'm
happy
to
answer
any
questions.
A
A
E
Thank
you,
chairman
and
committee.
The
the
conversations
I've
had
with
kathleen
in
representing
the
nurse
practitioners
is
over
two
there's
the
way
the
line
I'm
just
going
to
read
the
language.
So
it's
clear
an
advanced
practice
registered
nurse
with
a
certificate
of
fitness
issued
pursuant
to
this
chapter
may
arrange
up
to
10
or
10
of
the
12
required
annual
remote
site
visits
by
a
collaborating
physician.
E
E
A
E
E
You
know
between
now
and
full,
and
I
would
appreciate
if
you
could
help
me
get
this
out
of
here,
so
we
can
have
that
conversation
and
talk
about
a
possible
amendment
that
may
be
accommodating
in
that
format.
But
but
I
think
this
is
more
than
fair
and
and
I've
talked
to
many
of
the
nurses
and
doctors
in
my
district
and
across
this
state,
and
they
concur.
This
is
a
huge
step
forward
for
nurse
practitioners.
A
B
B
A
A
A
B
A
Forward
we
have
any
objections
to
that
motion.
We
have
a
second,
dr
terry.
I
think
second,
so
if
there
are
no
objections,
we
will
be
voting
to
send
this
to
full
committee,
and
I
do
want
our
staff
had
had
said
as
before.
Even
though
we've
amended
the
bill,
there
still
is
a
conflict
between
portions
of
the
bill.
They
they
notify
section
5
and
section
6..
So
my
recommendation
would
be
to
address
that
when
you
make
your
alterations
between
here
and
full
committee.
A
A
G
G
A
G
You
chairman
of
members,
this
bill
would
create
a
pilot
program
for
alzheimer's
care
across
the
state,
a
respite
program
currently
in
the
state
and
the
amendment,
the
only
language
that
the
amendment
changed,
allowing
for
the
reporting
of
costs
to
be
through
the
triple
a
ds
in
our
communities.
But
many
of
you
may
or
may
not
know
that
I
lost
my
grandmother
two
years
ago
to
alzheimer's
after
nine
and
a
half
years
struggle
with
it.
G
One
of
the
biggest
challenges
we
find
with
family
members
who
have
alzheimer's
is
the
family
members
try
to
care
for
their
needs
and
if
the
longer
a
family
can
care
for
the
needs
of
their
loved
one,
the
more
we
can
keep
those
people
out
of
long-term
care
when
they
have
alzheimer's.
What
this
respite
care
program
will
be
a
pilot
for
three
years:
it'll
allow
for
150
families
across
the
state
to
get
three
or
four
hours
a
week
of
respite
care.
It's
very
important.
G
Those
those
people
will
be
able
to
go
the
grocery
store
for
them
and
their
own
families,
if
it
weren't
for
my
two
aunts
and
my
mother
it'd
been
very
difficult
for
my
my
grandmother
to
stay
in
her
own
home
for
as
long
as
she
could.
What
this
would
do
is
give
support
to
those
families
across
the
state.
The
name's
the
bill
is
named
after
colonel
bowden,
which
is
in
representative
sam
whitson's
district,
who
also
is
an
advocate
for
alzheimer's.
G
We
we're
hopeful
that,
through
this
pilot
program,
we
can
do
some
measurable
some
measures
to
find
out
if
we
were
able,
through
this
respite
care
program,
to
keep
people
out
of
long-term
care
and
that
they
would
be
able
to
stay
home.
I'm
happy
to
answer
any
questions
the
members
have
regarding
the
amended
bill.
A
D
G
G
This
bill,
as
amended,
would
trip
would
say
it
would
be
for
the
aaads
which
most
of
us
have
in
our
communities
already
and
those
monies
would
be
distributed
to
them
and
then
therefore
distributed
much
like
any
of
the
other
care
programs
that
we
have
with
the
choices
or
or
those.
And
so
that's
that's
where
the
money
would
end
up
going.
G
I
will
say
that
as
an
addition,
chairman
and
members,
this
is
not
new
to
the
united
states.
State
florida
passed
similar
legislation
many
years
ago,
and
they
found
that
it
was
of
great
benefit
to
its
citizens
and
the
governor
of
florida
this
year
added
an
additional
15
million
dollars
to
the
budget
for
this
kind
of
care
which
which
we
hope
that
we
find
that
in
the
future,
would
be.
We
can
help
our
citizens
in
the
same
way.
H
Well,
you
brought
the
point
up
them
when
they
go
into
an
unfamiliar
surrounding,
like
the
you
know,
assisted
living
or
the
nursing
home
that
can
sometimes
when
you,
when
you
get
them
out
of
a
normal
environment,
they
may
go
down
much
quicker
and
require
greater
amount
of
of
healthcare
dollars
on
that
end.
So
this
is
maybe
a
short-term
or
small
amount
on
the
front
end
that
saves
us
on
the
on
the
back
end.
A
G
Thank
you,
chairman
of
members.
This
bill
is
seeks
to
make
changes
to
the
physician
referral
law
in
tennessee
in
1989,
the
united
states
enacted
the
federal
physician
self-referral
law,
commonly
known
as
the
stark
law.
The
stark
law
prohibits
physicians
from
referring
patients
to
any
entity
or
health
care
services.
If
the
physician
has
a
financial
relationship
with
that
entity
and
with
with
a
few
exceptions
soon
after
1989,
the
number
of
states
adopted
what
we
call
many
stark
laws.
G
G
The
nature
of
this
federal,
stark
law
and
federal
several
states,
including
tennessee's
neighboring
states
in
virginia
and
tennessee,
have
added
provisions
to
their
many
stark
laws
to
clarify
that
any
business
arrangement
which
is
or
may
be
permitted
under
the
federal
stark
law
shall
also
be
permitted
under
the
state's
mini
stark
law.
This
bill,
similar
to
tennessee's
law,
has
several
benefits.
The
bill
would
align
its
federal
and
state
stark
laws
together
in
a
business.
G
If
a
business
arrangement
is
prohibited
under
the
federal
law,
it
would
also
be
prohibited
in
tennessee,
and
if
a
business
arrangement
is
permitted
in
federal
law
than
it
would
also
be
permitted
in
tennessee.
This
bill
would
eliminate
the
need
for
the
general
assembly
to
update
its
mini
stark
laws
based
upon
federal
changes,
and
the
bill
would
also
allow
for
the
tennessee
board
of
medical
examiners
to
discipline
any
medical
providers
of
any
unethical
behaviors.
G
A
Then,
thank
you
for
the
explanation.
It's
reassuring
to
see
that
the
board
still
retains
authority
over
the
situation.
We
have
any
comments
or
questions
on
this
bill.
If
none
no
objections
we'll
be
voting
to
send
this
bill
to
full
committee,
all
those
in
favor
say
aye
any
opposition
so
approved.
Thank
you,
chairman
of
members,
great
job.
G
A
A
A
We
have
an
amendment
that
makes
the
bill.
We
have
a
motion
and
second
on
the
amendment
and
we
we,
let's
make
sure
we
have
a
motion.
Second,
on
the
bill.
I
missed
that
have
proper
motion.
Second,
on
the
bill
and
the
amendment
we're
going
to
put
the
amendment
on
the
bill
since
it
does
make
the
bill
all
those
in
favor,
say:
aye,
any
opposition
so
approved.
We're
back
on
the
bill
is
amended.
You
are
recognized
for
an
explanation.
A
A
Of
health,
so
do
we
have
any
comments
or
questions
and
and
the
reason
I'm
I'm
so
interested
in
the
bill
it
it's
similar
to
a
bill
that
I
have
coming
up
in
a
week
or
two
and
but
but
they're
for
totally
different
populations.
So
I
just
want
to
get
everybody
to
understand
this
is
this
is
a
bill
for
a
specific
group
of
people?
That's
left,
underserved
and
so
mine
is
for
a
different
population.
A
J
A
J
Thank
you,
mr
chairman,
and
thank
you
committee.
This
bill
requires
employers
of
health
care
prescribers
to
report
to
the
tennessee
bureau
of
investigation
and
local
law
enforcement,
as
well
as
department
of
health
time.
They
run
into
an
instance
where
somebody
has
diverted
drugs
by
fraud
or
just
stole
them
any
controlled
substance
and
that
particular
crime
that
goes
with
it
to
dispense
it
or
administer
it
or
acquire
it
by
fraud
or
forgery
or
deception
or
subterfuge.
J
D
J
Hulsey,
thank
you.
That's
exactly
right.
There
seems
to
be
a
mechanism
where,
if
they
get
caught
or
suspicion
that
their
a
nurse
is,
is
stealing
somebody
else's
medication,
sometimes
the
provider,
the
employer
will
just
fire
them
and
it
doesn't
get
reported
and
they
go
higher
on
someplace
else
and
do
the
same
thing.
There
is
a
mechanism
that
the
tma,
I
think,
supports
that
that
says
they
can.
When
they
get
caught,
they
can
say
yeah,
I'm
addicted.
A
A
J
D
And
and
maybe
while
we're
out
of
session
as
well,
we
can
ask
the
question
of
legal
here,
but
the
way
I
look
at
it,
it
says,
violation
of
the
section
is
a
class
d
felony.
So
that
means
the
employer
must
file
a
report
with
the
department
of
health
report.
It,
the
tbi,
which
could
be
a
class
d
felony,
is,
is
punishable
of
up
to
12
years
in
prison
in
a
fine
of
five
thousand
dollars.
Is
that
is
that
not
accurate?
A
D
A
K
K
K
63-1-126
is
current
law
regarding
the
failure
of
drug
screens
by
health
care
providers
back
to
the
bill,
mr
chairman,
we
also
tma
find
the
reasonable,
reasonable
suspicion
standard
and
representative
halsey's
bill
to
be
vague
for
our
employers
to
interpret
with
me
now.
I
am
going
to
hand
this
off
to
dr
barron
from
the
tennessee
medical
foundation
he's
going
to
outline
our
concerns
as
it
would
affect
the
foundation.
K
I
I
I
am
the
medical
director
of
the
taxi
medical
foundation,
which
is
a
separate
organization
from
the
tennessee
medical
association.
Our
nickname
is
the
tmf
stands
for
tennessee
medical
foundation.
I've
been
the
medical
director
for
over
five
years,
I'm
a
board-certified
anesthesiologist,
a
dictionalogist
and
psychiatrist.
I
I
Our
sobriety
rate
at
five
years
is
over
85
percent
much
higher
than
anything
in
the
general
population.
I'm
also
the
volunteer
medical
director
for
the
nashville
davidson
county,
drug
court
dc4
and
the
women's
recovery
residents.
These
programs
take
care
of
non-violent
felony
drug
offenders.
I
have
seen
firsthand
how
difficult
life
and
employment
could
be
with
a
felony.
On
your
record,
I
was
appointed
to
the
board
of
medical
examiners
in
2010
by
then
governor
bredesen
and
reappointed
five
years
later
by
then
governor
haslam.
I
During
those
four
years
I
was
chair
of
the
csmd
oversight
committee.
I've
helped
write
many
rules
and
regulations
for
the
departments
of
health
and
mental
health,
including
the
tennessee
chronic
pain
guidelines.
I
say
all
this
because
I
care
about
and
have
worked
hard
to
improve
the
health
care
in
our
state.
I
I
I
When
a
provider
gets
arrested
for
addictive
behavior,
they
lose
their
job,
have
punitive
actions
on
their
license
or
lose
their
license
completely
and
are
unemployable.
That
is
an
avoidable
outcome,
especially
when
the
disease
can
be
and
is
successfully
treated,
and
the
provider
successfully
returned
to
work.
We
have
really
good
peer
assistance
programs
like
the
tmf
in
tennessee
for
physicians,
pharmacists,
dentists,
nurses
and
other
licensees.
I
I
They
are
monitored
for
five
years
or
longer
they
go
from
impaired
to
repaired
if
they
violate
their
monitoring,
they
go
back
to
treatment
or
get
reported
to
the
licensing
board,
and
then
punitive
action
is
then
applied.
We
do
not
have
a
revolving
door
or
hide
sick
providers.
We
communicate
closely
with
other
states
as
well.
I
This
bill
would
have
a
negative
impact
on
the
stigma
of
getting
help,
which
is
already
a
big
problem.
Physicians
and
nurses
are
already
resistant
to
gain
help
for
a
mental
illness
because
of
the
potential
repercussions,
loss
of
license
loss
of
hospital
privileges,
loss
of
their
job.
This
bill
will
only
add
to
the
fear
of
getting
help.
It
will
drive
providers
with
any
type
of
illness,
mental
or
medical,
further
underground,
physicians
and
others
monitored
in
our
program.
Do
not
get
lost
to
follow
up,
do
not
go
from
job
to
job.
I
This
bill
may
actually
promote
what
is
trying
to
prevent,
as
providers
will
be
encouraged,
not
to
get
help
and
to
quickly
leave
their
employment.
If
there's
a
hint
of
trouble,
I
understand
what
this
bill
is
trying
to
accomplish.
The
problem
is
complex
and
on
multiple
levels.
We
currently
have
good
systems
in
place
to
deal
with
these
complex
issues.
I
L
I
I
Someone
that
breaks
into
a
drug
store
to
steal
drugs
generally
isn't
stealing
drugs
for
themselves.
They
are
diverting
that
for
money,
physicians,
nurses
that
divert
drugs
in
hospitals
or
write
prescriptions
to
themselves.
It's
for
their
own
use,
it's
for
their
own
drug
use,
they're,
not
diverting
it
putting
it
on
the
street,
harming
other
people
they're
just
harming
themselves.
K
Chairman,
mr
representative
smith,
to
add
to
that
with
respect
our
health
care
providers,
especially
physicians,
they
they
are,
they
they
have
some
different.
The
the
profession's
treated
differently.
If
they
are,
they
do
violate
the
the
terms
of
their
license.
They
are
reported
to
a
national
provider
database
which
I
don't
think
is
the
same
for
average
tennesseans,
there's
no
national
database
if
you're
you're
you're
fired
from
a
job.
So
there
are.
There
are
some
some
differences,
especially
with
physicians,.
L
We
should
get
to
know
each
other
appreciate
y'all
coming
today,
and
I
want
to
echo
what
my
colleague
said.
I
think
it's
I'm
actually
surprised
to
learn
that
that
physicians,
nurses
and
employees
in
the
medical
community
can
can
steal
and
not
be
reported.
I
mean
I'm
kind
of
shocked
at
that
and
and
and
in
this
day
and
age
with
narcotics,
opioids
everything,
I'm
I'm
really
surprised
that
to
see
the
opposition
to
this.
What
just
out
of
curiosity?
What
was
your
amendment
going
to
do.
I
It
would
mandate
treatment
and
a
referral
to
the
medical
board
if
they're.
If
they
opted
out
of
treatment,
we
do
have
physicians
in
our
program
that
have
felonies
on
their
record.
I
could
think
of
three
offhand
very
easily
that
were
arrested.
That
was
their
entry
in
into
into
getting
help
all
three
of
them.
Only
two
one
went
back
to
work
in
a
jail
of
all
places
and
the
other
two
are
still
looking
for
work
and
they're
they're
they're
licensed
individuals.
I
I
Addiction
is
a
disease,
and
we
need
to
treat
not
only
physicians
with
addiction
with
I
know
appropriately,
but
the
general
population.
I've
worked
with
law
enforcement.
I
have
a
good
friend,
that's
high
up
in
the
tennessee
bureau,
and
he
and
I
was
quoted
saying
we
cannot
arrest
our
way
out
of
this
problem.
We
have
to
provide
prevention
and
treatment.
That's
how
we
get
out
of
this
problem.
L
If,
if
they
were
reported,
there
would
still
be
the
option
of
the
facility,
whether
they
wanted
to
press
charges,
and
the
district
attorney
would
have
the
authority,
I'm
sure,
to
divert
them
into
some
program
like
this.
Why
not
let
the
legal
system
just
work
its
work,
its
way
out?
It's
it's
unlikely
that
if
they
truly
had
an
addiction
that
they
would
go
to
jail,
I
would
imagine
that
that
they
would
end
up
in
a
program
like
this
anyways,
dr
brown,.
I
B
I
B
And
what
I
see
the
problem
could
be
in
this
legislation
is
that
if
the
doctor
saw
the
theft
or
them
taking
it
and
they
wanted
to
help
them
out
and
they
did,
but
they
later
found
out
that
you
didn't
turn
them
in
then
you're
going
to
be
the
one
that's
in
trouble
for
not
turning
them,
in
which
I
think
that
could
be
a
real
problem.
Yes,
sir,.
D
Yeah
I
do,
and
I
want
to
ask
a
question
and
make
a
comment
on
what
we've
been
talking
about
so
currently,
as
a
business
owner,
we've
had
to
change
our
policies
as
in
we
don't
take
cash
anymore.
Some
of
these
things
to
make
sure
that
some
of
our
employees,
the
the
opportunity
crimes,
if
you
will
are
removed
and
almost
without
exception,
we
have
worked
with
our
employees,
recognizing
they
are
in
a
tough
position,
and
I
I
kind
of
look
at
it.
D
What
you're
saying
here
as
a
similar,
similar
crime,
it's
a
crime
of
opportunity.
If,
if
I
broke
into
the
hospital
and
had
possession
of
a
narcotic,
the
crime
is
multiple
steps,
but
breaking
and
entering
would
be
one
of
them
which,
if
a
if
a
physician
or
a
nurse
is,
is
diverting
a
narcotic
that
the
crime
is
not
necessarily
possession
as
much
as
it's
illegal
possession
or
legally
obtaining
it.
And
I
I
too
agree
that
you
know
we
we
cannot.
D
We
cannot
criminalize
this
out
of
existence.
We
cannot
continue
to
put
people
in
prison
and
and-
and
you
know,
remove
their
ability
to
make
a
living.
We
need
to
make
sure
they
get
they
get
help,
and
so
is
is
my
understanding
correct,
and
I
think
we
just
we
just
addressed
it.
You
would
not
have
the
ability,
if
this
passed
to
work
with
a
with
an
employee,
to
make
sure
they
get
help.
You
would
be
forced
to
turn
them
over
to
law
enforcement
is
that
is
that
the
understanding.
I
K
H
You
and
I
just
want
to
get
a
clarification
on
this-
basically
an
addiction
being
a
a
medical
issue,
a
disorder
versus
diversion
where
you're
selling
and
there
are
laws
on
the
books
for
diversion
to
sell
that
they
would
be
punished
under
under
that
if
they
were
selling
it.
What
you're
saying
this
is
somebody's
medical
condition,
you're
getting
them
treatment
a
felony
to
them
and
give
you
an
example.
H
That
person
was
here
in
tennessee,
and
so
those
are
on
the
books
and
that's
a
felony
that
they
would
go
after
them.
For
that,
so
that's
different
than
somebody
that
has
a
medical
issue,
and
that
being
said,
you
know
when
you're
doing
your
medical
license.
Have
you
ever
had
a
drug
problem?
Have
you
had
a
felony?
L
Thank
you,
mr
chairman.
I'll
wear
a
name
tag
next
time.
I'm
on
this
committee.
I
just
want
to
clarify.
I
mean
I
want
to
make
sure
I've
got
this
right
because
listening
to
you
guys
talk
you're
talking
about
addiction
and
and
there's
nobody
on
this
committee,
including
myself,
that
wants
someone
turned
over
to
law
enforcement
for
having
an
addiction
and
and
if
a
doctor
did
have
an
addiction
we
would
hope
they
would
get
treatment
and
continue
with
their
with
their
career.
L
But
I
did
not
realize
that
a
physician
could
could
steal.
They
could
literally
steal
something
and
and
give
it
to
give
it
to
their
friends
or
sell
it
or
take
it
themselves
or
whatever
and
that
they
were
getting
away
with
that
that
crime-
and
I
I
just
have
a
problem
with
that-
it's
not
the
addiction
part,
it's
the
stealing.
It
part
that
I'm
concerned
with,
and
so
I
just
I
maybe,
when
we
go
back
into
session
the
sponsor
can
clarify.
I
thought
we
were
talking
about
the
fact
that
they
were
stealing
medicine.
I
Thank
you,
sir
addiction
is
a
dirty
disease
if
someone's
diverting
drugs
for
their
own
use.
Writing
you
know
prescriptions
to
themself.
Those
drugs
are
not
ending
up
on
the
street.
That
is
part
of
the
disease
of
addictions
like
driving
under
the
influence
of
alcohol
part
of
the
disease
of
alcoholism.
I
If
they're
writing
prescription
for
monetary
gain,
that's
not
addiction
and
those
people
should
be
punished
under
the
law,
but
this
bill
would
punish
everybody
under
you
know.
If
they're
diverting,
you
know
if
they
have
a
sample
of
hydrocodone
in
their
office
and
they
use
it
for
their
own
use
and
their
employer
found
out.
A
A
So
answer
your
questions,
you
recognize
the
and-
and
I
I
think
questions
have
popped
up.
Somebody
sent
me
a
text
here,
what's
reasonable
suspicion
and
and
what's
the
criteria
for
an
employer
without
some
kind
of
definition,
what's
a
reasonable
criteria
for
an
employer
being
an
expert
on
that
it
can
certainly
be
difficult,
and
I
think
this
is
an
excellent
spot
for
us
to
recognize
regulatory
boards
because
they
do
take
care
of
these
issues.
A
The
dental
society
or
dental
association
has
a
rehab
program,
the
medical
association,
I'm
sure
the
nurses
do
too,
and
we
all
recognize
the
words
that
come
to
us
from
dr
steven
lloyd
he's
become
spokesperson
statewide
for
opioid
addiction
having
suffered
through
it
himself,
were
he
to
have
suffered
the
incarceration
and
and
legal
issues
that
would
come
from
a
bill
like
this.
Would
he
have
been
in
a
position
to
be
in
that
that
spokesperson
today,
or
would
he
have
been
an
ex-con
that
that
nobody
would
listen
to
and
and
he's
a
huge
powerful
voice?
A
J
Rehab
a
truck
driver
who's
got
an
addiction
to
alcohol
and
he
wrecks
his
truck
and
he
gets
arrested
and
he
gets
a
license
suspended
it's
taken
away
and
he
loses
his
job
until
he
can
earn
it
back
and
he
very
well
may
go
to
rehab,
but
but
he
doesn't
bypass
the
criminal
justice
system.
This
is
the
only
profession
in
this
state
that
we
do
this
to,
and
I
want
to
tell
you
most
of
the
time
and
by
state
code.
J
If
you
go
in
front
of
a
judge
on
these
kinds
of
charges,
you
get
diversion,
you
get
it
judicially
to
go
to
rehab.
So
I'm
I'm
not
against
rehab.
I
think
it's
absolutely
essential.
It
doesn't
always
work
up
in
bristol.
There
was
a
nurse
in
there
and
a
covered
ward,
stealing
the
guy's
medicine.
That's
in
an
induced
coma,
so
bad
to
the
place
that
he
wakes
up
and
that's
how
it
was
discovered
and
not
reported
by
the
supervisor
under
this
law
he
would
have
to.
J
I
think
it's
absolutely
essential
and
I
think
it's
important,
but
this
is
the
only
profession
that
we
do
this
way
and
divert
around
the
judicial
system
and
the
criminal
justice
system
when
crime's
been
committed,
and
so
that's
all
this
does
it
says
you
got
to
report
it
just
like
child
abuse.
You
don't
take
child
abuse,
folks
and
say
a
school
teacher
who's
supposed
to
report,
child
abuse,
but
talks
to
the
the
mom
or
the
dad
and
the
mom
or
the
dad
say.
Well,
look
I'm
going
to
I'll
go
to
rehab!
Oh
okay!