►
Description
House Health Subcommittee - March 30, 2021 - House Hearing Room 2
A
C
A
A
A
That
being
said,
do
we
have
any
questions
or
comments
of
the
sponsor?
I
did
find
it
interesting
I've.
I've
wondered
how
the
cobot
has
affected
the
capacities
in
nursing
homes,
and
I'm
told
that
pre-covert
they
were
about
76
now
they're
about
64,
so
we
have
suffered
quite
a
loss
and-
and
we
need
to
take
care
of
these
folks,
any
comments
or
questions,
if
not
we'll
be
voting
to
send
this
bill
to
full
committee,
all
those
in
favor
say
aye,
any
opposition
so
approved.
Thank.
A
F
This
bill
is
important
because
our
maternal
mortality
review
here
in
tennessee
found
that
african-american
women
are
three
times
more
likely
to
die
and
our
children
are
three
times
more
likely
to
die
than
any
other
race
of
women.
In
order
to
curb
this
issue
to
ensure
that
all
women
have
equal
chance
at
life
and
their
children,
we
want
to
make
sure
we're
studying
on
some
of
the
imp
the
factors
that
impact
african
american
women
that
cause
us
to
suffer
such
loss.
A
F
Thank
you.
It
requires
the
department
to
create
an
evidence-based
implicit
bias,
training
program
for
health
care
professionals
related
to
maternal
infant
mortality,
and
I'm
just
wanting
to
read
a
couple
of
star
startling
facts
to
you
is,
which
is
why
I'm
pushing
this
particular
bill.
A
2016
study
found
that
nearly
half
of
his
first
and
second
year,
medical
students
believed
that
black
people
have
thicker
skin
than
white
people
and
perceived
black
people
ex
experiencing
less
pain
than
white
people.
An
idea
born
for
the
19th
century,
experiments
that
were
conducted
by
a
physician
named
thomas
hamilton.
F
He
was
a
wealthy
plantation
owner
who
regularly
tortured
and
enslaved
black
black
men
named
john
brown,
creating
blisters
all
of
his
body
in
an
effort
to
prove
black
skin,
went
deeper
than
white
skin.
A
2019
study
published
in
the
american
journal
of
emergency
medic
medicine,
analyzed
data
from
14,
previously
published
studies
on
pain
management
and
found
that
black
patients
were
40
percent,
less
likely
to
receive
medication
for
acute
pain
compared
to
white
patients
and
34
percent,
less
likely
to
be
prescribed
opioids.
F
That
is
a
problem,
and
we
want
to
ensure
that
our
doctors
are
knowledgeable
and
aware
of
many
of
the
pre-con,
the
the
the
diseases
and
the
socio-economic
impacts
that
african-americans
go
to
through
the
impact,
our
health.
So,
in
order
to
do
this,
we
want
to
implement
implicit
bias.
Programs
provide
training
for
doctors
and
medical
professionals,
so
they're
aware
of
the
cultural
implications
that
individuals
in
our
state
have
so
that
we
can
care
for
our
patients
and
meet
them
where
they
are,
so
they
have
equal
chances
of
living,
receive
equal
health
care
treatments.
F
But
I
also
understand
that
every
a
lot
more
people
want
to
take
part
of
this
conversation.
So
if
it's
okay
with
you,
I
want
to
really
push
this
issue
again.
We
found
that
black
women
are
three
times
more
likely
to
die
than
white
women
and
we
want
to
make
sure
that
we
have
a
chance
to
live
as
well,
and
that
requires
holding
our
doctors
accountable
as
well.
So,
in
order
to
let
everyone
be
a
part
of
this
discussion,
I
would
like
to
motion
that
I'll
receive
a
summer
study.
F
Thank
you
and,
as
the
committee
said,
y'all
honestly,
I
like
health
care
and
are
very
interested
in
health
care.
Then
it
is
my
third
bill
in
front
of
the
committee
today,
but
with
that
being
said,
I'm
changing
the
course
and
I'm
focused
on
human
trafficking.
With
this
particular
legislation.
We
want
to
ensure
that
our
medical
professionals
are
adequately
trained
on
human
trafficking
and
how
to
deal
with
human
trafficking
victims
when
they
come
into
the
emergency
room.
F
Now
what
we
do
know
a
lot
of
human
trafficking
victims
are
scared
to
go
to
the
emergency
room,
because
our
medical
professionals
don't
necessarily
know
how
to
deal
with
them.
We
have
issues
with
our
red
kids.
They
are
scared
of
their
perpetrators,
will
find
out
they're
going
to
seek
help.
We
could
potentially
send
them
back
into
the
arms
of
someone
who
harmed
them
or
send
them
into
the
justice
system
when
they
really
need
some
other
form
of
help.
F
A
And
thank
you
very
much
any
questions
or
comments.
The
the
summer
study
has
been
moved
and
these
are
important
issues.
The
I've
noticed
that
several
of
the
health
professions
have
have
required
continuing
education,
specifically
for
this
last
subject
that
you've
addressed.
So
we
look
forward
to
being
a
part
of
your
discussion
and
helping
for
meaningful
efforts
next
year.
F
You
I
want
to
say
thank
you
to
the
committee.
I
would
love
for
all
you
all
to
participate
in
the
summer
study
and
give
me
your
opinions
and
contribute
and
then
to
all
my
healthcare
professionals
in
the
audience
who
are
listening
and
are
interested
in
any
of
the
things
that
I'm
talking
about
again.
Would
love
for
you
to
take
part
in
my
summer
study,
and
I
hope
that
you
contact
me
in
the
van
so
that
I
can
bring
you
in
on
this.
So
thank
you,
committee
and
I
appreciate
your
support.
A
Motion
a
second
and
and
thank
you
for
the
motion,
a
second
this
this
bill
is,
is
in
acts.
What
we
have
named,
the
james
dustin
samples
act
and
what
we
are
trying
to
do
with
this
legislation,
and
we
brought
it
up
last
year
and
and
it
moved
on
ahead.
The
bill
creates
a
legal
presumption
that
a
firefighter
diagnosed
with
post-traumatic
stress
disorder
by
mental
health,
professional.
A
As
as
we
see
the
majority
of
the
situation
that
the
firefighters
are
involved
in
really
reflect
emt
and
and
health
issues,
and
these
are
are
very
stressful,
very
traumatic
and
they
are
exposed
to
many
times.
The
normal
level
of
these
instances
that
the
average
public,
or
even
some
other
first
responders
are
are
subjected
to.
The
bill
applies
to
any
firefighter
who
is
diagnosed
with
post-traumatic
stress
disorder
within
three
years
of
the
firefighter's
final
date
of
employment,
with
the
employment.
A
Maybe,
oh,
I'm
sorry.
I
thought
we
had
someone
to
speak
about
james
dustin's
samples.
He
was
a
young
firefighter
that
took
his
own
life
and
it
reflects
the
issues
that
we
face
today,
where
many
of
these
firefighters
not
being
presumed
to
be
in
the
difficult
situations
that
they
are,
that
they
hide
evidence
of
post-traumatic
stress
and,
and
so
sometimes
it
can
and
has
often
almost
three
times
the
rate
of
of
average
citizens
often
drives
them
into
taking
their
own
lives.
That's
what
this
bill
is
about.
H
Chairman
ramsey,
I
want
I
want
to
thank
you
and
for
bringing
this
legislation
forward,
and
I
applaud
your
efforts.
Dustin
samples
was
a
was
a
good
friend
of
mine
that
suffered
in
silence
and
fell
through
the
cracks
and
didn't
get
the
proper
help
that
he
needed,
and
I
just
I
applaud
your
efforts,
and
this
is
good
legislation
here
and
I
I
just
thank
you
for
bringing
this
forward.
G
A
I
I
believe
it
is
thousand
feet
of
a
park
that
this
is
we're
not
dealing
with
schools
but
dealing
with
parks,
and
what
this
would
do
is
to
allow
those
entities
or
agencies
that
provide
syringes
and
so
forth
to
persons
in
the
parks,
with
the
intent
being
to
lessen
the
hiv
and
other
transmittable
diseases
that
take
place
when
people
congregate
in
that
manner
and
this
well,
you
might
be
right,
mr
chairman,
about
an
amendment.
This
would
be
repealed
in
december
of
2023..
I
A
I
A
I
A
C
Thank
you,
mr
chairman.
Thank
you,
representative
hakeem,
yes,
sir,
so
I
assume
that
there
is
an
existing
program
for
needle
exchange
in
these
areas
and
that
is
conducted
by
non-profit
voluntary
organizations.
Yes,
sir,
and
what
was
the
reason
that
the
restriction
was
put
on
about
certain
distance
from
schools
and
so
forth.
I
I
Hakeem,
thank
you,
mr
chairman,
because
of
covet
people
were
moved
out
of
the
the
shelters
and
they
started
to
congregate
in
the
parks.
This
is
in
the
major
cities,
and
so
this
is
what
has
changed
and
what
is
happening
in
those
areas.
Is
that
an
increase
in
in
hiv
and
other
infections
and
so
forth
and
the
effort
is
to
limit
as
best
possible.
I
G
Thank
you
chairman.
I'm
just
trying
to
get
clarification
on
this,
so
it's
the
bill
would
authorize
a
needle
exchange
program
to
be
conducted
within
any
distance
of
a
park,
but
not
a
school,
correct,
correct,
okay,
and
so
currently
it's
2
000
feet,
except
for
chattanooga
and
knoxville
memphis,
and
then
it's
1000
feet
scoring
park.
So
this
is
strictly
for
davidson,
county
chattanooga
and
knoxville
and
memphis
there's
no
school
and
it's
for
a
park
for
a
sunsetted
period
of
time.
B
I
I
don't
believe
we
would
utilize
a
place
like
coolidge
park
if
I'm
understanding
correctly
that's
homeless,
have
not
in
a
sense
of
speaking
taken
over
an
entity
like
coolish
park,
but
there
may
be
in
a
community
or
neighborhood
around
we'll
say
the
downtown
area
that
this
is
happening.
What
what
street
is
that?
The
11th
street
area?
You
know,
there's
a
problem
near
the
community
kitchen.
You
know
places
like
that.
Yes,
ma'am.
B
Yeah
and
again,
I'm
not
I'm
just
trying
to
understand,
because
I
think,
while
we're
trying
to
meet
a
need,
we're
also
trying
to
avoid
an
unintended
consequence.
And
while
you
know
the
predominant
number
of
people
that
are
going
to
be
at
a
park,
whether
it's
on
11th
street
or
at
coolidge
park
or
or
they're,
going
to
be
kids
they're,
going
to
be
families
that
are
seeking
green
space
and-
and
I
don't
know
that
we
want
to
turn
an
open
green
space
into
a
facility
for
something
as
invasive
as
a
as
a
needle
exchange.
B
You
know
there
are
mobile
units
that
are
available
and
if
I
wonder
if,
if
it
wouldn't
be
better
to
engage
with
certain
health
entities
on
a
mobile
temporary
basis
to
go
into
areas,
and
rather
you
know
than
parks,
you
know
try
to
meet
people
at
the
homeless
kitchen
or
the
the
the
shelters.
Thank
you,
mr
chairman,.
I
Representative
hakeem,
thank
you
very
much
well,
as
I
said
to
my
knowledge
and
understanding
entities
like
coolish
park
and
and
others
of
that
nature
are
not
considered
in
this,
and
then
you
we
would
have
the
county
and
the
city
having
input
into
something
like
that
being
done,
and
the
only
area
that
I'm
familiar
with
right
now,
where
this
would
take
place,
would
be
in
that
11th
street
area
in
the
area
near
the
community
kitchen,
where
people
have
camped
out.
You
know
that
type
of
thing.
G
Thank
you,
chairman
and
representative
smith,
actually
brought
something
up
that
I
would
hope
that
maybe
be
considered
as
opposed
to.
I
know
this
be
temporary
and
talking
about
mobile
there
being
a
difference
between
a
physical
building
versus
someone,
that's
doing
outreach
in
the
park,
and
maybe
that
may
be
something
to
consider
as
opposed
to
as
this
is
structured.
G
Maybe
it's
you
know,
keep
it
a
thousand
feet,
but
they
may
enter
the
park
or
you
may
have
out
outreach
into
the
park
or
maybe
500
feet
and
outreach
into
the
park,
just
something
for
the
the
committee
to
consider
that
we
keep
keep
the
actual
facility
or
whatever
away
from
the
park.
But
you
allow
the
outreach
in
there.
That
may
be
just
something
to
consider.
I
Hakeem,
yes,
sir,
I'm
sure
that's
something
that
could
be
explored
as
far
as
the
mobile
piece
but,
as
you
spoke
of
the
outreach,
would
be
entities
agencies
going
into
these
areas
and
when
we
talk
about
parks,
we're
not
talking
about
where
families
and
children
are
we're
talking
about,
essentially
where
people
have
have
set
up
camps
so
to
speak
and
that
well,
I
guess
it's
an
area
I
didn't
expect,
wouldn't
expect
families
and
children
to
be.
If,
if
you
follow
me.
G
A
We
have
further
comments
or
questions
of
representative
hakeem.
If
not,
we
will
be
voting
to
send
this
to
full
committee.
All
those
in
favor
say
aye.
Any
opposition
so
approved
all
right,
and
I
would
note
that
you
can
carry
your
bill
forward
without
the
sunset
on
it.
Yes,
sir
and
then
conform
to
the
senate
bill
and
or
else
you
can
amend
it
in
the
process,
the
same
as
the
senate.
Thank
you
very
much,
mr
chairman
and
members.
We
move
on
to
item
10
house
bill
1489
by
representative
towns,.
A
J
Thank
you,
mr
chairman
house,
bill
710
looks
to
address
some
complications
with
certificate
of
need
on
hospitals
or
institutions
that
are
reopening
after
being
closed.
Present
law
generally
requires
that
a
a
person
obtain
a
certificate
of
need
before
establishing
a
health
care
institution,
changing
the
bad
compliment
or
instituting
certain
health
care
services.
J
This
bill
creates
an
exception
to
present
law,
whereby
a
certificate
of
need
will
not
be
required
for
a
licensed
hospital
if
number
one
the
hospital
is
previously
licensed
or
another
hospital
was
previously
licensed
at
the
proposed
location
number
two.
The
hospital
is
located
in
a
county
that
has
been
designated
by
the
department
of
economic
and
community
development
as
a
tier
2,
tier
3
or
tier
4
enhancement
county,
or
that
has
a
population
less
than
forty
nine
thousand
number
three,
the
last
day
of
operation
at
the
hospital
site.
J
Pursuant
to
this
bill
and
the
party
seeking
to
establish
the
hospital
applies
for
certificate
of
need
from
the
health
services
and
development
agency
within
12
months
of
the
date
on
which
the
party
submits
information
to
the
department
pursuant
to
this
bill,
this
bill
is
to
make
it
easier
for
our
rural
hospitals
that
have
closed
that
have
that
have
parties
coming
in
that
are
looking
to
reopen
them
to
to
help
expedite
the
reopening
of
those
hospitals
and
with
that
I'll,
take
any
questions.
Okay,.
A
I
A
C
A
A
K
K
Two
are
very
involved
in
research
of
pediatric
rare
diseases,
saint
jude's
in
memphis
and
vanderbilt
here
in
nashville,
and
they
are
part
of
a
series
of
consortia
that
deal
with
these
rare
diseases.
There's
a
real
problem
that
rare
diseases
present,
and
it
is
that
researchers
have
difficulty
accumulating
the
data
points
that
they
need
to
make
reasonable
decisions.
When
you're
talking
about
things
that
we
all
get
like
heart
disease,
there
are
millions
of
people
that
get
it
and
it's
deeply
studied.
When
you
have
rare
diseases,
it's
hard
to
accumulate
that
information.
K
It's
still
widely
recognized
that
developing
systems
to
sort
information
about
rare
diseases
is
really
needed
to
facilitate
the
study
of
these
diseases.
Just
recently,
in
july,
2019
in
the
journal
of
rare
diseases,
the
authors
from
all
across
the
world
called
for
appropriate
legislation
to
further
the
information,
the
information
sharing
among
these
critical
institutions.
So
I
believe
that
we
in
tennessee
can
create
a
statute
that
can
then
become
a
model
statute
that
states
can
pass
to
allow
to
create
the
legal
infrastructure.
K
B
Thank
you
chairman,
I'm
just
curious
of
the
sponsor.
How
does
this
last
within
the
last
two
years,
we
formed
the
tennessee
rare
disease
advisory
council
with
the
state,
and
it
was
charged
specifically
to
work
not
just
with
the
pediatric
space
but
throughout
all
ages
and
and
devoted
to
make
seamless
the
treatment
and
the
study.
Is
this
not
a
redundancy?
Thank
you,
mr
chairman.
No.
K
It's
not
the
advisory
council
is
there,
as
I
understood,
and
I
was
very
focused
on
that
when
that
legislation
was
passed,
is
there
to
create
to
essentially,
as
many
advisory
councils
are,
to
create
the
most
seamless,
effective
approach
to
treating
these
diseases
in
the
state
of
tennessee.
In
other
words,
make
sure
all
the
institutions
are
talking
to
each
other.
The
resources
are
properly
allocated.
I
view
that,
as
mostly
an
intra-state
issue.
This
is
different.
This
is
about
these
institutions
that
specialize
in
rare
diseases
transferring
instant
institutional
information
among
states
and
across
national
borders.
K
So
I
think
it's
a
different
thing.
Obviously
the
advisory
council
will
have
to
have
its
opportunity
to
speak
if,
in
fact,
this
bill
got
legs
and
we
were
talking
about
moving
legislation,
so
I
think
they're
compatible
they're
ins,
the
this
legislation
seeks
a
compatible
goal,
but
with
a
slightly
different
focus.
A
L
Yes,
sir,
mr
chairman,
I'm
at
the
will
of
the
committee,
but
I
do
plan
on
taking
this
bill
off
notice.
However,
I
would
like
to
adopt
one
of
the
amendments
and
I
can
explain
the
amendment
because
I
think
it's
just
an
important
component
as
I
continue
to
work
on
this
piece
of
legislation.
Just
the
amendment
that
I
was
hoping
to
get
on
is
5837.
A
L
L
B
B
Yeah,
thank
you
and
we
agree
that
I
think
that
we
can
do
a
better
job
of
using
tanf
and
snap
to
bridge
that
benefits
gap.
I
think
we're
talking
the
same
thing
in
the
same
population,
but
but
I
I
don't
necessarily
feel
good
about
removing
one
of
the
key
measurements
as
far
as
income
and
adopting.
Let's
put
this
way,
things
that
happen
in
washington
d.c
have
not
proven
to
be
very
effective
here
in
tennessee.
A
A
A
A
What
this
bill
does
is
add
cerumen
management
to
the
authorized
scope
of
practice
to
be
performed
by
licensed
hearing
instrument.
Specialists
under
the
council
of
hearing
instrument
specialists
requires
a
licensed
hearing
instrument
special
to
follow
regulations
established
by
the
council
regarding
cerumen
management
to
carry
appropriate
professional
liability
insurance
before
performing
the
removal
and
maintain
proper
infection
to
know
practices
and-
and
I
would
like
to
submit
an
amendment
6203
to
that
effect.
A
G
A
G
Chairman
was
six
two
zero
three
was
that
in
our
amendment
pack,
I
I
I'm
understanding,
that's
the
amendment
that
was
worked
out,
but
it
may
not
be
in
our
amendment
packs.
So
if
that's
the
case,
was
this
timely,
a
timely
filed
amendment
and
if
that's
the
case,
then
we
have
to
do
some
procedural
motions.
A
C
G
A
A
N
A
N
Yes,
sir,
thank
you
chairman
committee.
For
several
years,
child
care,
early
education
providers
and
members
of
the
tennessee
association
for
children's
early
education
have
been
unable
to
get
consistently
reliable
and
prompt
information
from
the
department
of
human
services
about
policy
changes,
grant
operations
and
related
issues.
N
A
M
A
M
Mr
chairman,
I
also
request
to
roll
this
one
of
the
hill
different
rationale.
This
time
this
bill
is
in
reserve
for
chairman
zachary's
bill
going
forward.
If
his
bill
goes
forward,
this
one
is
probably
going
to
be
unnecessary.
On
the
other
hand,
if
his
doesn't
I'm
going
to
run
this
bill,
so
I
request
to
roll
it
to
the
heel
as
well.
Okay,.
A
A
M
M
A
M
M
I'm
not
quarreling
with
the
idea
that
they
make
recommendations,
that's
not
part
of
the
bill,
but
on
the
basis
of
testing
and
by
the
way,
if
you
want
a
statistical
discussion,
I'm
glad
to
give
you
one,
but
what
it
boils
down
to
is
when
you're
testing
individuals
that
already
show
symptoms,
you
get
a
very
low
rate
of
false
positives.
When
you're
using
the
test
as
a
screening
device,
you
get
a
much
higher
rate
of
false
positives.
M
At
the
time
I
wrote
the
request
to
the
department
of
health.
There
were
several
studies
out
there
that
had
caused
me
to
write
that
question
of
the
part
of
health
and
those
false
positive
rates,
one
of
which
was
put
out
by
the
cdc,
was
six
percent.
Another
one
which
was
put
out
by
another
very
highly
recognized
and
prestigious
organization
was
as
high
as
26
percent,
and
what
that
boiled
down
to,
ladies
and
gentlemen,
is
that
we
had
as
many
as
60
000
people
in
our
state.
M
At
one
time
they
were
told
they
had
a
positive
test
and,
of
course,
the
fact
that
it
wasn't
positive
was
good
because
they
didn't,
they
didn't
develop
the
disease.
However,
they
were
quarantined.
They
were
not
producing
economic
output
for
our
state,
so
we
as
a
state
suffered
economically
by
virtue
of
having
all
these
people
and
by
the
way
that
number
went
up
as
the
number
of
tests
went
up.
M
M
I
will
specify,
too
that
this
bill
requires
no
change
to
current
law
and
that
test
results
that
are
asked
for
from
these
labs
still
go
directly
to
the
requesting
health
care,
professional.
There's
no
intent
to
change
that
and
there's
no
intent
to
change
the
fact
that
each
of
these
healthcare
labs
do
their
own
quality
control
measures
in
most
cases
on
a
daily
or
more
frequently
basis.
M
The
idea,
though,
is
that
our
own
department
of
health
has
no
real
handle
on
what
these
are,
so
this
bill
requires
that
a
report
be
made
to
oh
by
the
way.
Mr
chair,
I'm
sorry
there
is
an
amendment
on
this.
I've
just
explained
the
amendment.
Does
the
amendment
make
the
bill?
Yes,
sir,
the
amendment
number
is
4495..
Let.
A
M
The
idea
behind
this
is
to
create
a
mechanism
whereby
our
state
agency
has
an
idea
of
what
the
medical
laboratories
in
our
state
can
do.
Now,
there's
been
some
misunderstanding
that
went
as
far
as
washington
d.c.
I
got
a
an
objection,
memo
from
a
board
of
pathologist
group
in
washington
dc
the
misunderstanding
that
they
had
was
in
the
bill
that
specifies
a
statistically
valid
sample
plan.
M
They
were
operating
under
the
incision
under
the
impression
that
the
millions
of
tests
done
by
these
medical
laboratories
would
all
have
to
be
sent
to
the
state
catalogued
and
examined
again.
They
did
not
understand,
in
fact,
that's
on
page
two
of
the
amendment
that
it
requires
a
statistically
valid
sample.
M
As
someone
who
earned
a
living
in
the
field
of
statistics,
I
can
tell
you
it's
possible
to
create
a
statistically
valid
sample
with
as
few
as
100
samples,
so
we
don't
need
millions
millions
to
characterize
this.
The
labs
are
already
doing
these
tests
anyway.
This
is
merely
a
method
of
consolidation,
consolidating
these
reports
so
that
we
know
as
a
state
through
our
health
department
what
the
medical
capabilities
of
our
labs
are
right.
M
I
will
point
out
also
that
again,
the
idea
here
is
not
to
measure
every
test
of
every
laboratory,
a
statistical
sample
which
is
far
cheaper
and
far
easier
to
do,
and
it
would
also
provide
the
medical
laboratory
board,
which
is
in
charge
of
doing
this,
the
means
for
doing
that
they
are
a
fee
supported
organization.
No
money
comes
out
of
the
general
treasury
for
this
without
explanation,
I
stand
ready
to
answer
questions.
E
You,
mr
chairman,
and
represent
reagan:
how?
How
would
how
would
they
know
if
it's
a
false
positive,
maybe
if
you've
got
a
certain
percentage
that
are
false,
but
you've
got
the
possibility
of
the
false
ones
that
are
actually
false
are
positive?
I
mean
spreading.
The
disease
looks
like
to
me:
you
wouldn't
have
a
choice
at
that
time.
You've
got
this.
If
it's
positive,
then
you've
got
to
act
right
then
you
can't
assume
that
is
a
certain
percentage
positive.
M
M
M
You
can
also
double
sample.
There's
a
myriad
of
techniques
that
you
can
do,
which
do
not
delay
and
provide
the
opportunity
for
us
to
to
see
that
now.
By
way
of
example,
there's
variation
in
all
things,
even
at
the
atomic
level,
for
example
you've
heard
of
carbon-14
dating.
But
if
you
look
on
the
periodic
chart,
carbon
is
12.,
so
if
you
have
variation
in
the
atoms
from
carbon,
for
example,
and
12
and
14,
you
have
variation
in
everything,
including
measurement
systems.
M
So
the
way
you
test
that
measurement
variation
is
you
measure
something
more
than
once.
You
will
never
get
exactly
the
same
answer.
If
you
do,
your
system
is
messed
up,
but
to
see
how
close
you
get
to
the
same
answer
is
the
goal,
and
in
the
case
that
we
were
talking
about
here,
that
methodology
is
simple,
straightforward
and
again
I
want
to
emphasize
a
statistically
valid
sample,
that
is
to
say
the
millions
of
tests
that
are
done.
M
All
of
them
don't
have
to
be
done.
That
way,
you
do
random
selection,
which
any
statistician
will
tell
you
is
the
key
random
selection
of
various
labs
and
various
samples
and
ask
them
to
do
a
split
sample
or
double
sampling
or
any
other,
a
bunch
of
other
techniques
and
report
that
to
the
the
central
organization.
E
Speaker
marsh-
and
I
understand
that
you
could
do
that,
and
I
see
what
you're
saying,
but
we
were
under
a
really
critical
time
frame
with
this
disease
and
we
had
to
have
it
tested.
I
mean
I
was
frantic
to
get
a
test
a
couple
of
times
and
I
didn't
want
to
wait
another
couple
of
weeks
to
get
the
results
back.
I
wanted
to
know
whether
I
should
quarantine
or
keep
working,
so
I
just
don't.
I
just
don't
understand
how
you
can
do
that
quickly.
I
guess
that's
my
question.
M
M
The
the
parallel
running,
yeah
you're,
going
to
pay
for
that,
but
again
a
statistical
sample,
like
I
said,
100
can
characterize
millions
and
by
way
of
example,
I
would
invite
you
to
consider
what
they
report
on
elections,
millions
of
people
vote
on
election
and
they
put
out
a
statistical
sample.
Usually
they
sample,
like
800
people,
to
predict
the
behavior
of
the
millions
of
voters
across
the
nation,
so
a
statistical
sample
will
accurately
predict
the
the
millions
of
results.
M
The
important
piece
that
is
missing
here
is
our
governor
was
told
that
we
have
this
many
positive
tests
and
therefore
we
we
must
do
something
the
governor
had
to
make
a
decision,
but
he
was
not
told
that
out
of
these
tests
anywhere
between
six
and
26
percent
were
false
positives.
Now
there
was
also
some
false
negatives
in
there.
Don't
misunderstand
me:
you
can
have
two
alternatives:
we're
not
so
much
concerned
with
the
false
negatives.
M
The
false
positives
are
the
ones
we
reacted
to,
and
for
that
reason
I
think
that
the
governor
making
his
decisions
would
have
benefited
from
having
that
information.
It
may
not
have
been
a
different
decision.
Don't
misunderstand
me,
but
not
having
that
to
me
is
a
critical
piece
of
information
for
that
decision.
That
was
missing.
E
M
M
In
fact,
the
first
version
of
the
bill
that
I
wrote
was
intentionally
vague
to
give
them
as
much
authority
and
latitude
as
possible,
but
the
complaint
I
got
from
the
pathologists
and
some
others
was.
It
was
too
vague,
so
it's
now
in
there,
but
I
still
left
it
as
as
flexible
as
possible
for
them
to
be
able
to
choose
among
the
the
many
ways
that
they
can
do
this
to
implement
it.
M
Now,
if
you
want
to
get
to
specifics,
you
know
we
can
talk
about
the
pcr
test,
the
number
of
revolutions
and
so
forth,
and
so
on,
which
I
don't
think
is
something
we
need
to
get
into.
That's
in
the
weeds.
The
idea
behind
this
is
we
have
a
metrology,
a
measurement
system
across
the
state,
300
plus
labs,
and
we
depend
on
those
labs
giving
us
results.
They,
the
labs
themselves,
do
quality
control
measures;
they
keep
them
internally.
We're
not
asking
them
to
do
anything
extra.
M
N
Thank
you,
chairman
and,
and
I'm
kind
of
along
the
same
lines,
I'm
I'm
a
a
touch
confused,
because
my
understanding
is
when
a
test
gets
approved
for
use
that
there's
an
efficacy
report
that
talks
about
how
what
the
the
the
likelihood
of
a
false
positive
is.
I
know
every
test
that
I
took
there
was.
I
was
told
that
there
is
a
certain
percent
of
false,
positive,
false
negative.
N
Whatever
you
want
to
call
it,
and
so
I
guess
I'm
not
totally
sure
what
what
you're
asking
for
how
that
would
address
it,
because
if,
if
the
test
in
and
of
itself
has
a
built-in
range
of
false
positives,
how
would
running
that
test?
Multiple
times
affect
the
validity
of
a
test
chairman
reagan?
Thank.
M
M
I
made
a
living
for
two
decades
working
across
all
industries,
including
healthcare,
going
into
many
many
cases,
really
advanced
labs
and
finding
out
that
the
information
they
were
given
about
the
effectiveness
effectiveness
of
the
various
tests
they
were
trying
to
run
were
not
exactly
what
the
manufacturer
told
them
like.
I
said:
there's
variation
in
all
things,
there's
very.
If
I
were
to
give
you
a
yardstick
and
say
measure
the
length
of
this
table.
M
You
give
me
a
number
if
I
hand
the
same
yardstick
to
another
person
measure
it
they're
going
to
give
me
a
slightly
different
number,
there's
going
to
be
variation.
Yet
I
can
tell
you
with
with
certainty
that
the
length
of
that
yardstick
is
one
yard,
so
you're
going
to
ask.
How
can
we
get
different
measurements
unless
that
is
exactly
the
length
of
the
yardstick
times
twice
they're
going
to
have
to
interpolate
and
measure
between
so
you're?
Going
to
have
variation-
and
the
same
is
true,
even
with
very
sophisticated
lab
instruments.
M
N
Representative
freeman,
thank
you
and,
and
you,
you
kind
of
hit
on
exactly
what
I'm
saying
a
yardstick
is
a
set
length.
The
test
has
a
variation
within
it,
and
so
I
guess
I'm
not
understanding
how
running
the
test
multiple
times.
Knowing
that
there's
a
variation
within
the
test
and
again
you
said
it
yourself
if,
if
the
test
is
actually
not
as
as
as
effective
as
they're
saying
or
the
results
are
not
as
valid,
how
would
running
the
test
twice
change?
Any
of
that?
N
M
All
right,
in
the
absence
of
a
white
board
or
screen,
I
will
ask
you
to
trust
me
when
I
tell
you
that
bayesian
analysis,
combined
with
some
other
statistical
techniques,
will
enable
you
to
get
there.
Okay
and,
as
I
mentioned,
the
the
idea
of
testing
people
who
are
showing
symptoms
with
the
kind
of
test
you're
talking
about
and
by
the
way,
that's
what
they
give
you.
The
testing
people
that
are
showing
symptoms
yields
a
low,
false,
positive
rate
when
you're
using
it
as
a
screening
test,
which
is
what
we
did.
M
M
Someone
else
measures
it
and
they
say
no,
it's
two
yards
long,
plus
or
minus
a
half
inch,
there's
the
variation
in
the
measurement.
But
if
I
tell
you
my
yardstick
is
perfect:
it
measures
exactly
one
yard
that
doesn't
change
the
fact
that
when
applying
that
test,
you
have
variation
and
you
need
to
know
what
that
variation
is
when
you're
using
it
to
make
decisions
the
the
fancy
lab
equipment.
I
have
nothing
against,
don't
misunderstand
me:
it's
really
good
stuff,
but
even
it
has
variation.
G
Thank
you
chairman.
I'm
just
trying
to
wrap
my
head
around
all
this
and
trying
to
put
in
some
terms
that
I'm
familiar
with,
which
I
don't
know
that
other
than
maybe
a
couple
members
may
there
is
something
a
lab
that
is
drawn
called
the
pro-thrombin
time
pt
and
it's
and
there's
a
lot
of
variability
in
lab,
and
so
they
came
out
with
something
called
an
international
normalization
ratio
to
where
those
numbers
may
be
elevated
at
one
facility
versus
another
facility,
and
that
may
change
what
I
do
from
an
anesthetic
standpoint.
G
M
C
You,
mr
chairman,
thank
you
chairman
reagan.
I
wonder
if
it's
possible
to
simplify
a
complex
subject
in
the
sense.
What
we're
saying
is
there
is
variability
in
testing.
No
test
is
perfect.
All
the
time
the
decision
maker
who's
going
to
make
key
decisions
that
affect
public
health
based
on
those
reporting
should
know
the
variability.
How
bad
it
is.
Is
that
what
we're
trying
to
say.
A
M
M
A
A
A
G
A
A
O
O
It
would
be
the
responsibility
of
the
mother
and
the
abortion
clinic
or
the
facility
to
provide
their
expense
for
the
burial
and
cremation.
This
legislation
does
not
limit
or
restrict
abortion
or
access
to
an
abortion
facility.
It
only
attempts
to
guarantee
an
acceptable
level
of
respect
for
the
aborted
child
working
with
the
hospital
association.
This
bill
has
been
amended
and
we
have
excluded
hospitals
from
this
bill,
since
they
already
have
policies
that
reflect
this
bill.
O
Furthermore,
this
would
make
the
same
level
of
respect
applicable
as
currently
available
to
pets.
Right
now,
at
a
veterinarian,
when
your
dog
or
pet
dies,
the
veterinarian
is
required
to
ask
them
how
they
want
to
dispose
of
the
aborted
pet.
I
want
that
same
level
of
dignity,
aborted,
applied
to
a
child
and
also
have
some
testimony.
Mr
chairman,.
O
C
D
P
A
D
Great,
thank
you
so
much.
Thank
you,
mr
chairman
and
other
committee
members.
Thank
you
so
much
for
this
opportunity
to
speak
with
you
today
on
this
bill
again,
my
name
is
annette
lancaster.
I
was
the
health
center
manager
at
the
planned
parenthood
of
chapel
hill
north
carolina,
even
though
I
was
not
in
tennessee.
D
The
practice
of
meticulously
searching
through
the
contents
that
are
removed
from
the
mother's
womb
and
then
piecing
back
together.
The
fetal
remains
is
exactly
the
same,
regardless
of
where
the
abortion
is
being
performed.
Why?
You
may
ask,
because
if
any
of
the
remains
are
left
within
the
mother's
womb,
that
woman
will
become
septic
and
could
die.
D
There
was
no
appreciation
that
these
babies
were
human
lives.
If
you're
not
going
to
make
abortion
illegal.
The
least
you
can
do
is
not
further
desecrate
these
tiny
humans
and
afford
them
a
proper
burial
or
cremation
offering
a
proper
burial
or
cremation
for
these
babies
will
also
help
improve
the
mental
health
of
the
mothers.
D
The
fact
that
we
don't
even
offer
cremation
or
burial
as
an
option
to
these
women
just
shows
the
continual
dehumanization
of
what
we
know
is
human
life.
Even
the
words
we
use
in
the
abortion
industry
are
purposefully
chosen
to
dehumanize
the
entire
process.
We
say
patient.
Instead
of
woman
or
mother,
we
say
poc
instead
of
fetus,
we
say
remains
instead
of
baby.
D
D
P
Kelly
sure
thank
you,
so
I
not
only
worked
in
the
abortion
industry,
but
I
also
imposed
abortive.
I've
had
four
abortions
myself,
and
I
can
tell
you
that,
knowing
that
I
was
that
there
was
a
baby
that
I
was
aborting
at
the
time
when
I
did,
it
would
have
helped
me
heal
after
the
fact,
when
I
realized,
when
I
became
pregnant
and
kept
the
baby,
that
this
was
indeed
a
baby
that
I
had
aborted
when
I
was
in
my
younger
years.
P
These
women
are
in
crisis,
and
so
we
don't
want
to
have
hard
conversations
with
them,
but
terminating
their
child
does
not
end
the
crisis,
especially
if
we
don't
give
them
all
the
facts.
Informed
consent
is
something
that
you
do
in
any
procedure.
Getting
your
ears
pierced
getting
a
knee
surgery.
We
give
informed
consent
of
everything,
that's
going
to
happen
before,
during
and
after
the
procedure.
We
need
to
give
these
same
things
at
these
abortions.
Thank
you.
C
A
Q
D
Q
Q
Q
No
wonder
our
landfills
are
full
with
all
these
lives
that
we
are
throwing
away
in
these
landfills.
Yes,
sir,
I
appreciate
y'all
taking
having
the
courage
and
the
guts
to
come
and
tell
us
is.
I
wish
america
could
hear
what
you,
ladies
had
to
say
today,
what
we're
doing
to
our
our
people
in
this
world,
our
babies
and
and
it
just
touches
my
heart,
but
I
appreciate
you
all
very
much
letting
us
know
today.
Thank
you.
Thank
you.
B
Thank
you
sponsor
for
bringing
the
bill.
Thank
you,
ladies
for
being
courageous
and
being
strong,
and
thank
you
for
sharing
your
your
first
hand
and,
I
would
just
simply
say,
be
very
truthful
we're
living
in
a
culture
where
life
is
being
redefined
to
be
cells
and
to
be
less
than
human,
and
so
consider
me,
as
someone
who'll,
be
signing
onto
this
bill
as
a
sponsor
a
co-sponsor
with
you,
but
also
do
not
soften
your
voice.
B
Do
not
allow
culture
to
cancel
what
you're
doing,
because
that
which
a
culture
celebrates
is
that
which
we're
known
for
and
we're
going
to
all
stand
before
a
judge,
that's
much
more
greater
than
this,
this
this
life.
So
thank
you
and
god
bless
you
for
what
you're
doing.
Thank
you.
Thank
you,
chairman
chairman.
A
G
G
O
R
R
The
citizens
of
tennessee
year
in
and
year
out
allow
their
voices
to
be
heard
when
they
send
a
pro-life
super
majority
to
the
hallowed
halls
of
this
building.
They
express
without
hesitation
or
equivocation
that
this
state
has
an
interest
in
protecting
life
at
all
stages
and
treating
that
life
with
dignity
and
respect
in
2016.
R
Following
the
release
of
numerous
videos
from
the
center
for
medical
progress
that
exposed
the
serial
trafficking
of
fetal
remains
by
members
of
the
abortion
industry,
then
governor
haslam
took
it
upon
himself
to
sponsor
and
pass
legislation
that
required.
Reporting
on
the
disposal
of
fetal
remains
within
the
state
and
that
bill
also
prohibited
the
sale
and
trafficking
of
fetal
body
parts.
R
This
law
was
challenged
and
eventually
upheld
by
the
u.s
supreme
court
in
the
2019
case
box
versus
planned
parenthood,
in
a
seven
to
two
decision,
keep
in
mind
that
that
decision,
the
majority
vote
included
justices,
breyer
and
kagan
in
the
majority.
In
addition
to
the
conservative
justices
house,
bill
1181
seeks
to
mirror
indiana's
law
and
require
the
burial
or
cremation
of
fetal
remains.
There
is
nothing
in
this
legislation
that
burdens
a
woman
or
forces
her
to
do
anything
that
she
does
not
desire
to
do.
R
Let
me
be
perfectly
clear:
these
are
not
kidneys
or
gall
stones
or
someone's
appendix
these
are
the
remains
of
a
human
being,
and
regardless
of
the
decision
by
that
child's
mother
or
father,
this
human
being
deserves
the
dignity
and
respect
in
its
eternal
rest
and
those
of
us
that
sit
here
today,
I
implore
you
to
give
these
babies
their
dignity
and
respect
and
vote
to
pass
this
bill
out
of
subcommittee
on
to
the
full
health
committee
and
subsequently
onto
the
floor
of
the
house.
Thank
you
and.
R
R
A
N
O
As
far
as
I
know,
thank
you,
mr
chairman.
As
far
as
I
know,
there
are
no
current
law.
There
are
different
practices
of
different
facilities.
It's
my
understanding.
Some
abortion
clinics
break
the
baby
up,
grind
it
up
and
flush
it
down
the
toilet,
some
dispose
of
it
with
medical
waste
and
some
put
it
in
the
trash
bag.
E
Thank
you,
mr
chairman,
and
and
in
this
bill
who
would
be.
I
called
my
one
of
my
funeral
directors
this
week
and
asked
him
about
his
practice
on
infant
funerals,
and
I
asked
him
about
what
would
it
cost
he
said?
Well,
we
normally
try
to
do
them
least
cost,
and
sometimes
we
do
it
for
free,
but
if
you
have
to
pay
grave
diggers
and
casket
and
different
things
like
that,
he
would
he
estimated
that
it
would
cost
about
a
thousand
dollars
per
burial,
and
so
who
is
going
to
pay
for
this?
O
Asked
when
we
started
this,
I
asked
representative
alexander
what
it
would
what
it
would
cost
since
she's
in
the
funeral
business,
and
she
said
it
would
be
350
for
a
burial
150
for
cremation
plus
150
for
open,
open
burial,
and
she
also
said
that
most
funeral
homes,
especially
if
it's
a
small
fetus,
do
it
for
free.
They
don't
charge
anything.
K
O
In
the
physical
note,
there
is
there's
no
significant
cost
and
physical
note
at
the
bottom.
There
is
a
clause
that
states
what
morticians
all
that
would
pay.
That
is
simply
for
the
reporting,
that's
not
the
cost
of
the
the
barrier
or
cremation.
That
is
the
cost
of
reporting
this.
This
requires
a
report,
an
audit
to
be
conducted
annually,
so
they
know
that
the
remains
have
been
properly
handled
and
that
would
simply
that
states
that
there's
already
money
in
the
account
for
them
to
handle
that
reporting.
E
A
A
C
C
A
O
Bill
directs
the
department
of
health
to
form
a
provide,
a
form
that
form
would
be
would
go
through
the
system,
they
would
be
provided
the
options
and
they
would
choose
it
and
sign
it
or
refuse
to
sign
it.
In
that
case,
the
abortion
facility,
the
mother,
did
not
want
to
have
any
part
of
it
walked
out.
Then
the
abortion
clinic
would
have
to
fill
out
the
proper
paperwork
and
conduct
the
the
the
disposal
that
remains
properly.
O
A
O
A
Representative
hall,
you're
recognized
our
department,
chairman
hall,
I
have
the
we've.
Had
the
question
call
for
any
objections.
If
none
will
be
voting
to
send
this
bill
as
amended
to
full
committee,
all
those
in
favor
say
aye,
all
those
opposed
the
eyes
have
it
back
in
the
full
committee.
Thank
you
for
the
comments
or
questions.