►
Description
House Health subcommittee - March 8, 2022 - House Hearing Room 2
A
B
C
A
Welcome
further
personal
orders.
A
Okay:
okay,
yes
representative,
pardon
me
chairman,
cheryl
you're
recognized,
thank
you
chairman.
We
did
have
some
leadership
members
from
warren
county
here
today
and
I
don't
know
if
they've.
E
A
Yes,
welcome
to
all
of
you.
We
do
have
if
no
other
personal
orders.
We
have
some
orders
of
of
the
operation
today
we're
going
to
announce
bills
that
are
have
been
rolled,
but
first
I
was
told
by
the
speaker's
office.
They
were
to
restrict
people
standing
against
the
wall
unless
you're
waiting
to
be
a
sponsor
of
a
bill
and
other
than
that
we
will
move
forward.
A
A
Thank
you,
dr
bono,
for
your
service.
We
will
move
on
to
do
a
little
housekeeping.
We
have
several
bills
that
have
been
enrolled
or
taken
off
notice.
Item
number
37
house
bill:
2486
has
a
special
calendar.
Yes
has
has
been
had
the
limit
of
its
calendaring
here
in
the
committee,
so
we're
rolling
that
to
a
special
calendar
to
be
considered
at
the
heel
of
our
final
calendar
item
38
house
bill
2843
is
rolled.
A
C
A
We
need
a
motion
and
second
on
the
amendment.
Second,
we
have
a
proper
motion
and
second
on
the
amendment
we'll
go
ahead
and
put
the
amend.
Does
the
amendment
make
the
bill
since
it
rewrites
the
bill?
We'll
put
the
amendment
on
the
bill,
all
those
in
favor
say:
aye
any
opposition
we're
back
on
the
bill
as
amended.
Your
recognized
chairman
terry.
C
Thank
you
again,
chairman
committee,
section,
one
of
the
bill.
Some
of
the
facilities
that
are
specifically
listed
should
fall
under
current
statute,
but
we
wanted
to
make
sure
that
there
was
clarity
over
those
facilities,
including
congregate,
living
facility
and
then.
Secondly,
the
intent
of
the
omnibus
bill
was
to
have
visitation
particularly
pertain
to
covet
19
patients.
C
If
it's
the
the
will
of
the
committee
I
would
like
to
if
we
can
pass
this
on
to
full
committee,
if
it's
the
will,
there's
a
part
in
section
section,
two
that
I'm
working
with
the
speaker
on
and
and
to
change
the
term
terminal
to
critical,
and
that
would
be
the
the
only
change
the
only
real
change
that
we
would
be
doing
for
that
amendment.
Okay,.
A
Do
we
have
any
questions
or
comments
on
the
bill
and-
and
I
would
advocate
for
you
being
able
to
do
that
in
between
here
and
the
full
committee
to
make
those
alterations
any
questions
or
comments
on
the
bill?
If
not
knowing
that
this
is
the
speaker's
bill,
we
will
be
voting
to
send
this
to
full
committee.
A
All
those
in
favor
say
aye
aye,
any
opposition
so
approved,
and
we
will
move
to
item
two
house
bill
2662
also
a
speaker's
bill,
and
I
think
chairman
hall,
you're
recognized,
have
a
proper
motion
and
second
on
the
bill,
do
you
do
we
have
an
amendment?
I
think
we
have
one
amendment
on
it.
B
That
is
correct,
mr
chairman.
Thank
you.
Yeah
drafting
code,
one
four,
six,
nine
seven,
mr
chairman,
historically
in
the
past,
the
department
of
health
would
hire
the
executive
director
of
pharmacy
house
bill.
2662
would
require
the
board
of
pharmacy
to
make
that
hiring,
and
with
that,
mr
chairman,
I
renew
my
motion.
A
A
A
We
will
move
on
to
item
three
house
bill.
2162
is
brought
to
us
by
chairman
eldridge
you're
recognized
on
house
bill
2162.
A
A
We're
good
on
that.
We
have
a
proper
motion
and
second
on
the
amendment.
Does
that
make
the
bill
it
does?
Yes,
sir
okay,
let's
put
go
ahead
and
put
the
amendment
on
the
bill,
all
those
in
favor
of
the
amendment
say:
aye
any
opposition
you're
on
the
bill,
as
amended
you're,
a
recognized
sir,
on
the
bill.
Thank
you,
mr.
F
Chairman
committee,
this
particular
bill
has
come
about.
Of
course,
it
is
an
administration
bill
and
I
do
want
to
thank
them
for
establishing
an
unlicensed
facility
strike
force,
and
this
came
about
last
year
in
march,
when
several
state
agencies
were
involved
in
investigating
a
couple
of
unlicensed
facilities
in
in
hamline
county.
F
There
were
about
eight
agencies
involved,
and
it
came
to
life
that
he
wasn't
sure
exactly
who
was
in
charge.
But
this
this
board
establishes
that
that
the
department
of
aging
is
working
to
to
make
sure
that
some
of
our
most
elderly
and
vulnerable
people
are
taken
care
of,
and
that's
a
short
explanation,
but
that's
the
jest
of
it.
It
establishes
a
what
it
does
establish
a
registry
where
these
facilities
are
recognized
so
that
the
people
can
go
to
the
the
website
see
what
the
facility
does
if
it's
been
in
trouble
before.
A
Do
we
have
comments
or
questions
on
the
bill
as
amended
I
was.
I
was
I'm
sure
that
we
have
a
great
need
for
these
unlicensed
facilities
and-
and
I
was
very
surprised
to
find
out
that
we
actually
had
them,
and
I
think
this
is
probably
a
wonderful
bill
to
bring
to
light
any
discrepancies
in
the
in
the
way
that
they
treat
their
folks.
So,
yes,
sir,.
F
A
F
Mr
chairman,
since
this
strat
strike
force
was
established,
there's
been
107
across
the
state.
That's
been
recognized
as
operating
an
unlicensed
facility
and
it's
it's
not
that
they're,
just
keeping
older
people
they're
keeping
people
with
mental
disabilities,
it's
a
pretty
wide
range
and
the
the
situation
there
in
hamlin
county,
just
kind
of
brought
it
to
light.
And
again
I
do
thank
the
administration
for
working
on
this.
A
Yes,
sir,
thank
you
for
bringing
the
bill
to
have
any
questions
or
comments
on
the
bill,
as
amended,
questions
been
called.
If
there
are
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
and
committee.
Thank
you
chairman.
A
I
think
chairman
zachary
you're
presenting
that
to
us.
You
are
recognized,
sir.
G
A
Let's
go
ahead
and
put
the
amendment
on
if
there
are
no
objections,
all
those
in
favor
of
the
amendment
say
aye.
Any
opposition
so
approved
we're
back
on
the
bill
as
amended.
You
welcome
to
discuss
it.
G
Thank
you,
mr
chairman.
Now
members
this
is
an
administration
bill.
It's
a
simple
clean
up
from
some
of
the
legislation
we
passed
during
the
covet
special
session
related
to
county
health
departments
just
provide
some
clarity,
does
three
things
in
particular:
clarifies
the
department
of
health
retains
all
authority
and
its
mission
for
routine
public
health
activities.
G
Additionally,
it
addresses
the
health
director
to
this.
This
legislation
prevents
confusion
over
disagreements
between
the
mayor,
the
health
the
health
director
is
to
appointed
by
the
commissioner
with
advisement
from
the
mayor
and
finally,
mr
chairman,
this
beer,
this
bill,
clarifies
county
health
officer,
may
continue
to
issue
orders
and
make
rules
related
to
county
health
issues.
Again.
This
is
just
clarification
based
on
language
that
we
passed
during
special
session
with
that
I'll
be
glad
to
answer
any
questions.
Okay,.
A
A
If,
if
none,
we
will
be
voting
to
send
this
to
full
committee,
all
those
in
favor
say
aye
any
opposition
so
approved.
Thank
you.
A
Thank
you,
chairman.
We'll
move
on
to
item
six
house
bill
2801,
I
think
that's
the
yes
you're
recognized.
A
To
roll
that
a
few
spaces
till
we
get
correct
on
the
right
amendment
to
go
on
that
bill.
Please!
Okay!
Yes,
sir!
So
no
objections,
we'll
roll
this
for
four
slots
here
on
the
calendar,
if
you
guys,
will
keep
track
of
that.
For
me.
A
I
have
a
different
amendment
than
according
to
what
we
have
on
the
list
today.
Okay
yeah,
we
will
row
you
four
slots
is
that
okay?
Thank
you,
charlie.
Okay,
we'll
move
on
to
item
seven
house
bill
2096.
A
A
Okay,
that
matches
we
will.
We
have
a
motion,
second
on
the
amendment,
and
we
will
be
putting
that
on
the
bill
since
it
makes
the
bill
all
those
in
favor
of
the
amendment
say:
aye
any
opposition,
we're
back
on
the
bill
as
amended,
you're
recognized
on
the
bill
as
amended
chairman
terry
right.
C
Thank
you,
chairman
committee
federal
law
was
updated
in
2020
to
allow
opioid
treatment
programs
to
report
to
state
prescription,
drug
monitoring
data
databases
like
our
csmd,
so
this
bill
essentially
line
us
up
with
federal
law
and
because
inpatient
treatment
is
part
of
a
different
program.
The
amendment
that
we
put
on
clarified
that
inpatient
treatment
was
not
included,
does.
A
A
A
D
D
Members
of
the
committee,
this
on
the
surface,
is
a
very
simple
bill,
but
it
deals
with
literally
life
and
death
circumstances.
We've
we've
had
obviously
a
difficult
last
couple
of
years.
Fighting
this
pandemic
and
there's
some
great
treatments
out
there.
There
are
some
fantastic
vaccines
out
there
and
there
have
been
lots
of
areas
of
our
life
that
that
has
affected
one
of
the
areas
that
I
did
not
realize
this
had
affected.
Until
recently,
a
friend
of
mine
in
their
district,
I
had
a
constituent
who
needed
a
kidney
transplant.
D
They
had
family
members
that
were
willing
to
be
tested
for
that
kidney
transplant
and
it
would
have
been
a
known
party
to
known
party
type
transplant
when
they
went
in
to
speak
the
doctors
about
that,
the
individual
that
needed
a
kidney
transplant
is
not
vaccinated
for
covet.
They
have
made
that
personal
decision
on
their
own
again,
I'm
not
here
to
debate
the
the
strength
or
weaknesses
of
that
particular
decision
on
their
part,
but
for
their
own
personal
decision.
They
have
decided
not
to
be
vaccinated
for
covet.
D
Unfortunately,
that
decision
apparently
triggers
within
the
medical
community
a
decision
on
their
part
that
if
you
are
not
vaccinated
for
covid,
then
you
may
not
get
an
organ
transplant
period.
End
of
story,
even
if
it
is
a
known
party
that
is,
that
is
willing
to
give
you
a
kidney.
This
bill
just
says
that
cannot
be
a
consideration
so,
whether
or
not
they're
vaccinated
for
cove.
D
All
of
that
they
can
still
take
into
consideration-
and
I
know
I've
talked
to
several
of
you
on
this
committee.
I
was
not
able
to
get
around
to
talk
with
everyone,
but
I
know
dr
kumar
and
I
have
had
a
very
spirited
back
and
forth
on
this,
and
he
has
an
enormous
amount
of
experience
in
this
area.
But
just
for
this,
I
just
don't
think
a
personal
decision
on
whether
or
not
to
be
vaccinated
for
kovid
should
give
you
a
death
sentence
on
the
fact
that
you
cannot
get
an
organ
transplant.
A
Mr
chairman,
okay,
yes,
representative,
jernigan,
you're,
recognized.
D
Yes,
sir,
absolutely
I
mean
any
other
vaccinations,
the
ones
that
have
been
out
there
for
years
and
everything
else
all
of
those
would
still
be
appropriate.
We
are
still
the
scientific
community
from
my
understanding
is
still
going
back
and
forth
on.
You
know
natural
immunities
and
covenanting
vaccinations
and
which
vaccinations
work
best.
So
just
during
this
time.
Right
now
it
is
literally
just
the
cova
19
vaccine.
That
would
not
be
a
consideration.
Any
other
vaccinations
would
still
completely
be
a
part
of
that
determination.
I
A
D
Lambert,
so
this
this
very
specifically
says
for
covet
19,
we
obviously
meet
every
year.
There
may
be
a
time
down
the
road
when
it
would
be
appropriate
to
revisit
this,
but
at
this
point
in
history
for
right
now,
while
all
of
this
is
still
in
turmoil,
we
should
err
on
the
side
of
allowing
these
folks
to
get
a
transplant
and
just
say:
look
if,
for
whatever
reason,
you've
decided
not
to
get
a
covet
19
vaccination,
then
that's
something.
That's
not
going
to
be
consideration
on
this
now.
D
It
does
not
have
a
sunset
anything
like
that,
but
I
will
tell
you-
and
I
I
can
only
give
you
my
word-
that
as
long
as
I'm
blessed
to
be
in
the
legislature,
I
think
this
is
something
we
should
revisit
in
years
to
come.
If,
for
some
reason
it
looks
like
it's
something
that
would
be
appropriate
for
right
now,
I
think
these
folks
should
be
able
to
get
an
organ
transplant.
Thank
you.
A
J
Thank
you,
mr
leader,
thank
you
for
discussing
it
beforehand,
and
I
see
your
point,
but
it's
not
a
matter
of
a
legislative
decision.
It
is
not
a
matter
of
discrimination
against
somebody
or
being
prejudiced
against
a
person
who
didn't
get
vaccination.
There
are
medical
reasons
that
a
transplant
would
not
be
done.
J
It's
important
because,
what's
the
point
of
transplantation,
if
the
body
is
going
you're
going
to
allow
the
body
to
reject
it,
so
anti-rejection
therapy
is
very
important.
What
is
anti-rejection
therapy?
It
is
basically
immunosuppression
we're
going
to
knock
the
immunity
out
of
that
person,
so
they
would
not
reject
this
foreign
organ
that
has
been
transplanted
in
their
body.
J
If
you
have
no
immunity,
you
have
no
immunity.
That
means
you're
liable
to
infections
than
normal
organisms
that
you
and
I
handle
fine
in
in
the
atmosphere,
but
these
people
are
prone
to
even
the
organisms
that
human
race
is
used
to
living
with,
but
no
those
become
infective
organisms
to
these
individuals,
so
they
are
very
prone
to
infection
and
transplanting
an
organ
have
to
have
immunosuppression
suppressing
their
immunity
opens
them
up
to
literally
every
infection.
That
itself
is
also
a
death
sentence.
J
No
doubt
about
it,
never
mind
the
antibiotics,
and
the
thing
is
that
the
this
is
what
we
call
if
people
have
other
compromising
conditions.
This
is
the
permanent
compromising
condition,
and
from
that
point
of
view,
I
can't
believe
that
there
would
be
a
transplant
program.
Now,
let's
look
at
akkovit,
omicron
is
a
relatively
mild
case.
I
had
it
after
taking
all
the
precautions
over
the
years
I
had
it,
it
was.
J
I've
had
codes
that
were
worse
than
that,
but
in
an
immunocompromised
person,
omicron
will
be
a
serious
threat
and
that's
the
that's
the
medical
nature
of
the
things,
and
for
that
reason
I
think
compelling
or
pushing
or
encouraging
a
physician.
I
don't
think
you'll
find
a
transplant
surgeon
who
would
do
so
because
you
have
to
immunosuppress
them.
No
immunity
means
no
immunity,
means
you're,
very
prone
to
infections.
J
Call
it
well
if
it
gets
into
our
legislative
statute,
so
it's
covered
today,
the
next
time
we'll
come
around,
so
we
did
it
for
kobe
but
general,
but
I'm
quite
certain
to
you.
Certainly
I
can
submit
to
you
that
it
would
be
impossible
to
find
a
transplant,
surgeon
or
a
transplant
program
that
would
do
so.
I
would
like
you
to
kindly
reconsider
this.
Kindly
think
it
out
a
bit
and
if
you
want
to
take
the
summer
to
study
the
matter,
I
would
join
you.
J
D
Famous
chairman
and
and
dr
kumar,
you
are
a
dear
friend
and
extraordinary
knowledgeable
in
this
area.
I'm
just
asking
for
these
folks
to
have
a
shot.
I
don't
know
if
they'd
have
to
isolate
or
do
whatever
is
necessary.
You
know,
but
some
of
these
folks
do
have
natural
immunities
and
we
are
all
still
working
through
how
powerful
that
is
versus
the
vaccine
or
in
combination
with
the
vaccine.
In
fact,
the
definition
of
fully
vaccinated
is
still
in
flux.
J
Thank
you,
mr
chairman.
No,
I
think
the
fact
that
there
is
not
a
second
speaks
for
itself
and
I
can
feel
the
cold
wind.
I'm
really
surprised
because,
sincerely,
I
think
I've
explained
it.
It's
just
in
the
the
leader
has
done
more
of
an
authority
job
of
it
and
thank
you
for
the
opportunity.
Congratulations.
A
Leader,
the
speaker
marsh,
you
recognized.
B
Thank
you,
mr
chairman,
and
later
I
would
like
to
ask
two
or
three
questions.
Is
this
happening
just
in
tennessee
or
is
it
happening
all
over
the
nation
and
do
we
have
a
like
a
national
registry
that
lists
everybody?
That's
on
the
transplant.
You
know
they're
ready
for
transplants,
leader
lambert
and
do
they
have
best
practices
if
they,
if
they
have
a
national
registry,
so.
D
I
all
fantastic
questions
that
I
have
been
asking
of
these
folks.
I
initially
thought-
and
this
case
came
out
of
williamson
county
as
where
this
individual
reached
out
to
their
senator
and
that's
how
it
came
to
be
leader
johnson
in
the
senate.
Has
this
and
we
initially
thought
that
this
was
probably
just
an
isolated
thing
that
dealt
with
maybe
a
few
doctors
at
one
hospital.
It
has
since
been
communicated
to
us
that,
apparently
this
is
an
issue
for
the
national
board
that
handles
all
of
this,
and
this
is
nationwide
becoming
an
issue.
D
Each
state
is
going
to
have
to
determine
how
they
deal
with
this
in
each
state,
but
it
is
actually
one
of
those
things
that
comes
out
of
more
of
a
national
conversation
on
this,
and
I
think
it's
perfectly
fine
for
different
states
to
handle
the
different
ways,
because
it,
what
may
be
good
for
tennessee,
doesn't
work
in
california
or
somewhere
else,
but
it
is
apparently
a
much
larger
problem
than
I
first
anticipated.
B
D
There's
nothing
in
here
that
makes
them
do
it,
and
my
hope
is,
is
that
if
we
put
this
in
the
law,
there
will
be
doctors
that
will
be
willing
to
work
with
that
patient
and
just
not
consider
this
one
soul
thing.
Consider
everything
else
about
that
patient.
Take
into
account
every
other
aspect
that
they
want
to
take
into,
but
just
this
one
thing
just
that.
Don't
consider
that
thing,
but
no
there's
nothing
in
here.
A
Speaker
marsh
okay,
dr
terry,
you
asked
to
be
recognized.
C
Thank
you
chairman,
and
to
clarify
something
on
here
the
bill.
It
says
that
solely
on
the
basis
of
vaccination
status
and
the
things
that
you
cannot
do
cannot
consider
an
individual
ineligible
now,
would
that
be.
C
D
So
they
cannot
deny
medical
other
services
related
to
the
trans
to
the
transplantation,
but
I'm
saying
it
is
not
our
intention
in
any
way
in
this
to
say:
that's
if
they're
going
to
do
it.
Okay,
I
mean
obviously
the
doctor's
point.
I
mean
they
don't
have
to
do
these.
They
can
say,
look
I'm
just
not
doing
it.
I'm
not
interested
in
this
case
now,
but
the
cannot.
D
They
cannot
consider
that
it's
similar
to
some
of
the
issues
that
we
passed
last
year,
where
we
said
look,
you
can't
take
a
adverse
action
against
an
employee
solely
on
the
basis
of
whether
or
not
they're
vaccinated
we're
just
taking
that
out
of
the
equation.
They
can
look
at
every
single
other
aspect
that
they
want
to.
C
So
I
guess
essentially
the
way
that's
worded.
If
I,
I
guess,
if
a
doctor
was
saying
that
they
weren't
going
to
do
a
transplant,
they
would
just
not
say
it's
because
your
transplantation,
they
could
say-
maybe
I
mean
because
your
vaccination
status,
they
could
say
you
know
what
other
other
risks
that
you
had
involved.
C
Okay
and-
and
this
is
you
know,
I
asked
to
be
recognized
because
this
is
one
where
it's
it's
a
very
difficult
for
me
to
be
in
because,
honestly,
I
agree
with
a
lot
of
what
you're
saying-
and
I
agree
with
the
chairman
of
insurance
he's.
He
knows
a
lot
about
about
this
and
I've
done
anesthesia,
believe
it
or
not.
We
have
you,
know
these
type
of
patients
as
well.
So
another
question
for
me
so
say:
there's
an
organ:
that's
coming
at
from
out
of
state
from
kentucky
alabama,
something
like
that.
C
Are
there
standards
elsewhere
that
that
would
put
limits
on,
or
that
would
say
that
this
this
may
only
go
to
somebody
that's
vaccinated.
Do
you
know
if
that's
something
that
applies
leader,
lambert.
D
So
I
do
know
the
answer
to
that
question.
So
now
we're
in
area
of
law,
which
I
know
more
about
than
the
intricacies
of
practicing
medicine.
I
trust
you
all
that
practice
that,
on
a
daily
basis,
to
do
that,
legally
speaking,
once
that
enters
the
state
of
tennessee,
that
they
would
have
to
buy
by
our
laws
and
and
everything
else
you
just
said
by
the
way,
is
100.
True.
D
The
first
point
that
you
made
saying
that
you
know
a
doctor
basically
is,
is
going
to
find
another
reason
if
they
don't
want
to
do
that
surgery.
Yes,
I
mean
that's,
probably
going
to
happen.
It
just
can't
be
this
reason,
but
yeah
I
mean
once
an
organ
or
anybody
I
mean
once
you
come
into
the
state
of
tennessee,
you
have
to
abide
by
our
laws,
even
if
there
is
some
other
guidance
or
anything
else.
C
Dr
terry,
thank
you
so
so
let
me
clarify
this.
So
if
an
organ
is
in
kentucky
and
the
the
procurement
team
is
there
and
they're
looking
for
people
and
they
call
tennessee
and
we
have
someone
that
matches
and
they
ask
the
question:
is
this
patient
vaccinated
and
we
say
no,
then
they
could
turn
us
down,
but
once
that
organ
gets
to
tennessee
we
could
not
turn
them
down
for
the
vaccination
status.
D
Yes,
our
law
does
not
go
beyond
our
state
borders.
I
mean
we
can't
control
what
another
state's
going
to
do
now.
I
would
hope
and
pray
that
if,
if
you've
got
an
organ
that
matches
up
with
somebody
that
that's
again,
the
whole
point
of
this
is
to
hopefully
make
this
where
that's
just
not
the
consideration,
they
look
at
everything
they
would
have
looked
at
before
kovid
I
mean
sars
has
been
around
for
years.
This
is
just
the
most
deadly
version
of
that.
It's
what's
called
coven
19..
D
We
we
have
a
vaccination
that
you
know
hopefully
has
helped
and
will
continue
to
help
significantly.
With
this
issue
I
mean
I
have
told
people
for
now
better
part
of
a
year
or
so
that
you
know,
I
encourage
folks
to
get
vaccinated,
but
it
is
also
a
personal
decision,
so
we
can't
control
what
happens
in
other
states,
but
we
can
control
here
whether
that
soul
thing
is
what's
keeping
somebody
and
by
the
way.
D
What
really
bothered
me
about
this
whole
situation
is
it
wasn't
like
in
the
particular
circumstance
where
this
came
from,
and
maybe
this
is
just
this
individual
and
their
experience
in
the
the
process,
but
that
was
like
one
of
the
first
questions
that
was
asked
and
it's
probably
because
obviously
we're
still
in
the
hopefully
the
last.
You
know
in
weeks
of
our
months
of
a
pandemic,
but
it
was
like
the
first
thing
they
highlighted,
and
they
said.
Oh,
if
you're
not
vaccinated,
never
mind,
there's
no
re.
There's
no
need
for
us
to
go
any
further.
D
C
Dr
terry
yeah,
thank
you
and
and
appreciate
your
indulgence
on
this.
This
line
of
questioning
so
in
the
event
that
the
transplant
surgeon
in
tennessee
knows
that
this
patient
has
been
a
coveted
survivor
and
ends
up
with
organ
failure,
or
something
like
that
they
could
advocate
on
behalf
of
in
an
organ
in
another
state
and
say
I
do
believe,
based
on
this
person's
natural
immunity
that
they
that
me
being
able
to
take
care
of
them
with.
This
is
something
that
I
I
could
do,
and
I
could
advocate
for
them.
Is
that
correct.
D
Absolutely
100
and
this
bill
allows
for
that
conversation
because,
right
now,
as
a
doctor,
you
could
you
could
feel
that,
like
you
have
a
patient
who
has
natural
immunity,
you
have
a
patient,
for
whatever
reasons
you
know
had
is
able
to
undergo
that
procedure
and
to
be
able
to
take
other
measures
to
protect
themselves
after
the
procedure,
and
you
know
as
a
doctor
that
that
person's
not
vaccinated
but
you're
willing
to
advocate
for
them.
That
is
exactly
the
scenario
this
bill
sets
in
place.
J
You
I
just
a
few
clarifications:
one.
The
distribution
of
these
organs
is
under
united
unos.
We
call
it
a
united
network
for
organ
sharing.
These
are
people
who
are
on
the
transplant
list,
their
antibody
or
antigens,
and
their
genetic
information
is
maintained
in
this.
When
a
kidney
becomes
available,
they
are
by
computer
matched.
Usually
it's
best
to
go
ahead
and
do
it
in
the
same
area,
but
then
again,
depending
on
various
rating
systems.
An
organ
may
need
to
be
transplanted.
J
What
you're
mentioning
is
a
living
related
donor
transplant
you're,
not
talking
where
somebody
has
had
a
tragic
accident
or
illness
and
they
have
died
and
bigger,
take
their
organ
in
that
situation.
So
still
the
eunos
protocols
do
apply,
and
I'm
I
have
not
checked
with
you
knows,
but
I'm
quite
certain
that
that
would
be
a
very
firm
part
of
the
protocol.
J
J
You
can
have
natural
immunity.
How
long
does
that?
Last
three
months,
six
months,
organ
transplant
is
going
to
be
there
forever
and
again
situations
gonna
come
up
where,
as
I
said,
omicron
is
nothing
more
than
a
bad
call
to
a
normal
person
to
an
immunosuppressed
person
with
no
immunity
that
that
could
be
very,
very
dangerous
to
a
death
sentence.
So
considering
those
circumstances,
you
look
at
number
one
point:
if,
by
that
it
is
a
actually
a
death
sentence
for
the
patient
to
go
ahead
and
give
them
a
transplant
and
then
immunosuppress
them.
You
stop
there.
J
You
don't
start
investigating
other
things,
because
that
itself
is
dangerous
enough
for
the
patient
and,
as
I
said,
natural
immunity
does
not
last
it
can
be
natural.
It
can
be
very
mild
because
if
you
had
a
case
of
kovitt
that
was
very
mild,
you
can
have
a
natural
meaty
for
a
little
while
it's
going
to
be
low
level.
If
you
had
a
very
serious
case,
it's
going
to
be
a
lot
more,
but
yet
it
may
last
more
than
three
to
six
months.
Transplant
is
going
to
last
forever
and
sincerely.
J
I
I
wish
you
had
checked
with
maybe
the
vanderbilt
transplant
program
and
so
on
and
found
found
out.
Well,
it
is
really
possible
to
do
it.
I
think
it
would
have
been
good
to
even
have
had
a
witness
to
come
and
testify
to
explain
to
us
all
this
that
I'm
saying
about
why
we
cannot
would
not
entertain
the
possibility.
We
will
not
go
beyond
the
first
step
and
investigate
the
other
matters.
Thank
you,
mr
chairman.
Thank
you,
mr
leader,
leader,.
A
D
And,
and
thank
you
representative
kumar
again
and
and
again
you,
you
really
said
it
better
than
I
could
have
there.
If
you
don't
get
past
that
first
check
box
right
now,
you
don't
even
get
to
investigate
whether
or
not
a
family,
member
or
anybody
else
can
give
you
an
organ.
I
mean
that
if
you
don't
check
that
box,
the
answer
is
no.
It's
not
going
to
happen
period,
end
of
story
and
the
exact
same
issue
that
we
are
all
struggling
with
with
covet
19.
Look.
D
If
somebody
had
this
figured
out,
I
don't
know
why
they're
being
quiet
about
it,
I
mean
it
is
a
difficult
thing.
We've
all
struggled
through
worldwide.
With
this
the
vaccinations,
the
same
issue
has
happened.
I
mean:
how
long
do
they
last?
How
long
does
that
immunity
last,
you
obviously
can
still
catch
covet
after
getting
a
vaccination,
seems
to
indicate
that
it's
it's
less
in
severity,
but
we're
still
working
through
all
that
again.
J
A
Sir
chairman
hall,
you're
recognized,
call
for
the
question,
mr
trump
any
objections
to
calling
for
the
question
on
the
bill
as
amended.
If
none
we'll
be
voting
to
send
this
amended
bill
to
full
committee,
all
those
in
favor
say
aye
any
opposition
the
eyes
have
it
so
approved.
G
A
We
will
move.
Excuse
me.
We
will
move
to
item
six.
I
think
chairman
cheryl
or
leader
cheryl.
You
were
recognized
on
item
six,
sir,
that
that's
house
bill
2801
and
I
think
you
have
an
amendment.
Yes,
that
makes
the
bill.
Thank
you
I'll
stand
for
a
motion.
We
have
proper
motion.
Second,
on
the
bill,
I've
asked
for
a
motion
and
second
on
the
amendment
have
proper
motion
and
second
on
the
amendment
we'll
put
the
amendment
on
the
bill.
All
those
in
favor
of
the
amendment
say
aye
any
opposition
passes.
A
Bill
which
this
is
simply
deleting
rehabilitation,
centers
and.
A
Yes,
chairman
jernigan
you're
recognized.
I
just
wanted.
I
To
this
is
a
good
bill,
and
I
just
wanted
to
thank
you
for
bringing
it
and
I
support
it.
Thank
you.
A
A
A
Okay,
sir,
do
we
have
comments
or
questions
on
this
bill?
If
none,
we
will
be
voting
to
send
this
bill
to
full
committee,
all
those
in
favor
say
aye,
any
opposition
so
approved.
Thank
you,
mr
chairman.
Thank
you,
mr.
F
A
We
will
move
to
item
11
house
bill
2705
by
representative
carringer
you're
recognized
on
the
bill.
We
have
proper
motion.
Second
on
the
bill.
K
A
Okay,
do
we
do
we
have
any
comments
or
questions?
I
I
assume
this
is
the
musician's
bill
that
we're
talking
about.
We,
I
think,
they've
been
around
to
see
us.
Dr
terry
you're,
recognized.
C
Thank
you,
chairman
and
committee,
and-
and
I
want
to
thank
you
for
carrying
this
legislation
as
someone
that's
an
asthmatic,
but-
and
I
do
want
to
talk
a
little
bit
about
self-governance.
That's
something
that,
for
me
is,
is
a
big
deal
and
having
constituents
or
having
people
bring
bills,
work
their
bills
and
and
the
individual
that
you're
working
with
has
done
a
fantastic
job.
Discussing
this,
I
do
this
one
of
the
issues
that
I've
had
with
this.
C
This
bill
as
a
whole
has
been
the
practicality
of
how
how
this
works
and
I've
advocated
for
doing
you
know
an
all
or
none,
because
my
concern
is
that
you
know
you
have
different
counties
are
going
to
be
different
and
your
even
municipalities
within
the
county
may
be
different,
but
I've
looked
at
you
know.
C
Is
there
a
way
to
do
this
under
tosha,
and
I
tried
to
talk
to
an
attorney
to
see
if
that
was
a
way
and
it's
it's
really
difficult
to
get
this
and
my
understanding
of
the
all
or
none
probably
has
less
chance
of
passing.
I
do
want
to
tell
a
little
bit
of
of
why
I'm
an
anesthesiologist
and
it
kind
of
goes
along
with
this.
The
person
that
brought
you
the
bill
as
a
musician.
C
You
know
they're,
they
have
issues
in
these
facilities,
these
age-restricted
venues,
you
know,
obviously
I'm
an
asthmatic
as
well,
but
I
have
no
musical
talent
so
that
limited
people
being
able
to
to
be
a
musician
but
growing
up
as
an
asthmatic.
C
I
wanted
to
be
a
pulmonologist
and
one
of
the
things
that
when
I
was
in
med
school,
you
know
you,
you
start
going
doing
your
different
rotations
and
such
and
I
could
not
physically
be
in
a
pulmonary
pulmonologist's
office
because
of
the
secondhand
smoke
or
just
the
the
the
smoke
on
people's
clothes.
I
I
just
I
could
not
breathe,
I
get
choked
up,
and
so
I'm
very
empathetic
with
this.
C
K
You
chairman
and
and
to
my
colleague
I
appreciate
your
comments
and
and
having
family
in
the
medical
field,
and
all
I
understand
exactly.
I
am
asthmatic.
K
Also
I
have
a
brother
and
a
son
and
all
and
and
and
I
did
sing
and
and
it's
very
difficult
when,
when
asthma
is
bothering
me
and
all
so,
I
the
musicians
for
smoke,
free
tennessee,
did
bring
this
bill
to
me
and
they
are
here
also
to
speak
if
we
need
for
them
to
speak,
but
from
serving
on
knox,
county
commission
and
from
knox
county
and,
as
you
know,
having
the
city
and
knox
county
separate.
I
know
how
hard
it
is
to
to
regulate
something.
K
That's
statewide,
because
each
county
or
each
city
and
all
you
know,
is
different
from
from
others.
And
so
I'm
a
big
supporter
of,
I
believe
in
it,
basically
where
our
locals
in
each
individual
county
and
all
can
kind
of
make
that
decision
as
to
what
they
feel
is
best,
but
again
we're
we're.
Looking
out
for
the
musicians
and
the
others
that
are
being
affected
by
this.
And
so
I
think
it's
a
good
place
to
start
and
I'd
appreciate
all
the
support
that
we
can
get.
A
If,
if
we
will.
C
Thank
you
that
appreciate
that
I
just
want
to
make
one
for
the
comment,
and
you
brought
this
out,
and
this
was
something
I
was
looking
at
toshi
and
I
just
want
to
make
people
aware
of.
I
think
it's
like
5.8
or
percent
of
our
gdp
is
essentially
tourism,
hospitality
and
a
lot
of
those
people
that
work
in
that
are
exposed
to
second-hand
and
smoke
as
well.
C
So
it's
not
just
for
musicians
that
would
be
impacted
by
this
and
and
some
of
those
folks,
you
know
they're
in
a
job
that
it
may
be
they're
trying
to
go
up
the
income,
mobility
or
the
maybe
in
that
job,
because
on
one
hand
they
want
to
perform,
but
then
there
may
be
a
struggling
artist
or
whatever,
and
this
is
their.
This
is
their
job,
so
they
can
do
their
other
job,
and
so
I
just
wanted
to
bring
that.
That's
it's
a
big
part
of
our
tennessee
industry.
Thank
you.
C
I
A
A
A
We
are
moving
to
item
12
house
bill
2250
by
chairman
vaughn.
We
have
a
proper
motion
and
second
on
the
bill,
the
I
think
there
is
no
amendment
time
to
understand
and
I
think
you
do
have
some
testimony
today.
Do
you
want
to
describe
the
bill
first
and
then
we'll
consider
testimony.
H
Yes,
if
I
can
get
my
seeing
devices
out
of
my
pocket,
thank
you.
Thank
you,
mr
chairman,
and
thank
you
committee,
we're
here
to
talk.
I
like
usually
like
to
joke
around
a
little
bit,
but
this
is
a
serious
issue
that
we're
talking
about
today
and
addressing
it
has
to
do
with
the
involuntary
commitment
of
people
who
are
under
mental
stress
and
how
that
occurs
within
health
facilities.
It
was
brought
to
me
by
the
tennessee
hospital
association.
H
The
I've
brought
numerous
bills
trying
to
deal
with
health
care
worker
shortage
throughout
our
state,
we're
seeing
a
diminishment
of
of
workers
which
has
the
potential
I'm
not
saying
that
it
does.
But
I'm
saying
it
has
potential
to
diminish
the
amount
of
care
that
that
people
need
and
whenever
somebody
shows
up
at
a
psych
hospital
in
distress,
then
that's
when
we
need
to
have
the
resources
to
alleviate
them
and
get
them
comfort.
H
An
involuntary
admission
occurs
whenever
a
person
poses
an
immediate,
substantial
likelihood
of
serious
harm.
This
is
included
in
state
law.
The
person
needs
care,
training
or
treatment
or
all
available
less
drastic
alternatives
to
placement
in
a
hospital
or
treatment
resource
are
unsuitable
to
meet
the
needs
of
the
person.
H
So
it's
my
understanding
that,
as
of
today
that
a
qualified
mental
health
professional
can
sign
sending
someone
to
that
situation
into
that
situation.
But
currently
a
doctor
is
required
to
be
the
second
signature
for
the
commitment
to
get
that
person
to
be
involuntarily,
detained
and
treated
in
the
hospital.
H
As
a
result
of
that,
we
believe
that
people
can
get
more
immediate
attention,
because
these
professionals,
health
professionals,
would
be
on
site,
whereas
the
shortage
of
doctors
is
precluding
that
and
whenever
you,
the
way
that
I
thought
about
this
was
was
pretty
it
broke
it
down,
pretty
simply
for
me,
and
that
is
whenever
an
advanced
practice
nurse
or
a
physician's
assistant
operates
under
under
the
end.
The
indirect
supervision
of
a
doctor
there's
30
days
allowed
before
20
percent
of
the
charts
are
reviewed
by
a
physician.
H
In
this
case
it
would
be
reduced
to
24
hours
and
that's
that's
the
bill
and
I'm
here
to
answer
any
questions
or
anyone
can
or
we
can
wait,
and
we
have
folks,
I
believe,
to
testify
on
both
sides
of
the
issue.
Any.
A
Any
questions
or
comments
and
if
not,
if
there's
no
objections,
we
will
allow
you
to
introduce
your
we'll
go
out
of
session.
Allow
you
to
enter
I'll.
A
And
we
will
give
you,
gentlemen,
three
minutes
and
invite
you
to
go
ahead
and
introduce
yourselves.
B
Yes,
sir
good
afternoon,
chairman
committee,
I'm
joe
birchfield
with
tennessee
hospital
association
thanks
for
having
us
here
this
afternoon,
I'm
joined
by
two
guests
who
are
going
to
do
most
of
the
talking
for
us,
but
just
want
to
share
what
has
already
been
stated.
The
tha
supports
this
legislation
that
will
resolve
a
persistent
challenge
in
mental
health
facilities
across
our
state
due
to
that
statewide
shortage
of
psychiatrists,
particularly
a
shortage
in
the
hospital
setting.
This
bill
would
leverage
the
training,
experience
and
qualifications
of
psychiatric
nurse
practitioners
and
physician
assistants
in
the
involuntary
admission
process.
B
These
clinicians
already
serve
multiple
roles
in
the
evaluation
and
admission
process
as
it
stands
today
and
in
caring
for
all
patients.
Generally,
this
bill
proposes
to
maintain
the
medical
model
of
physician
supervision
of
the
qualified
nurse
practitioners
and
pas,
while
enabling
more
efficient
and
effective
operations
and
care
for
patients
who
are
in
crisis.
L
Thank
you
all
for
having
me
today,
I'm
dr
andrew
pearce,
I'm
a
board-certified
psychiatrist
who
works
here
in
the
state
as
the
chief
medical
officer
at
trustpoint
hospital
in
murfreesboro,
I'm
charged
with
safeguarding
the
compassionate,
effective
and
timely
care
of
those
members
of
our
community
in
need
of
acute
psychiatric
services
as
tennessee
continues
to
see
a
growing
need
for
mental
health
service.
It
is
necessary
to
identify
new
approaches
to
this.
Care
is
provided
in
my
assessment,
allowing
qualified
psychiatric
nurse
practitioners
and
physicians
assistants
to
complete
the
second
set
of
involuntary
commitment.
L
Paperwork
on
behalf
and
under
the
supervision
of
a
psychiatrist
will
contribute
positively
to
delivery
of
vital
services.
Processing,
involuntary
admissions
requires
assessing
a
person's,
immediate
or
substantial
likelihood
of
serious
harm
and
the
need
for
care,
training
or
treatment,
as
well
as
confirming
that
all
available,
less
restrictive
alternatives
to
hospitalization
are
unsuitable
to
meet
this
person's
needs.
L
Challenges
with
this
process
are
particularly
apparent
during
overnight
shifts
when
there's
limited
availability
of
on-call
psychiatrists
psychiatrists.
Completing
these
assessments
are
unlikely
to
be
physically
present
in
the
hospital,
often
connecting
remotely
via
telephone
or
video
conference.
This
crucial
task
must
occur
at
all
hours
of
day
or
night,
which
results
in
a
substantial
burden
to
the
psychiatrist's
tasks
with
its
completion.
L
Current
state
law
allows
qualified
mps
and
pas
among
other
health
professionals
to
serve
as
the
first
of
two
required
signatures
on
certificates
of
need
for
involuntary
admission
to
a
mental
health
hospital.
Additionally,
hospitals
in
tennessee
routinely
use
nps
and
pas
for
court
hearings
as
experts
to
continue
involuntary
treatment,
where
necessary
in
a
particular
patient's
case.
L
Enabling
these
professionals
to
continue
to
work
within
their
training
and
qualifications
can
improve
our
ability
to
assist
patients
in
crisis
and
improve
patient
throughput
for
emergency
departments,
law
enforcement
concerned
loved
ones
and
individuals,
while
maintaining
the
long
and
honored
tradition
of
allopathic
medical
practice,
as
well
as
providing
support
to
help
manage
the
current
shortage
of
inpatient
psychiatrists
in
the
state
we're
no
longer
in
prior
generations
and
physicians
now
and
in
the
future.
Have
an
essential
role
in
the
global
care
management
of
patients
and
population
health.
L
In
order
to
fulfill
that
role,
we
must
involve
qualified
professionals
such
as
nurse
practitioners
and
physicians
assistants,
guided
by
engaged
psychiatric
supervision
to
ensure
that
all
patients
receive
the
timely
care
they
need
to
return
to
a
more
normal
and
productive
life.
Subsequently,
I
would
ask
that
you
support
this
bill.
A
Yes,
sir,
do
we
have
a
we
have
a
question
from
chairman
hall?
You
recognized.
B
Thank
you,
mr
chairman.
Dr
welcome
sir,
tell
me
what
I'm
what
I'm
missing
here,
because
I
don't
think
I
don't
think
I'm
grasping
it.
It
only
takes
two
signatures
to
take
someone's
freedom
away
when
there's
no
crime
that's
been
committed.
Is
that
correct,
dr
pierce?
What.
L
It
takes
at
this
time
for
an
involuntary
psychiatric
commitment
is
one
signature
from
a
qualified
professional
in
the
community.
In
our
case,
this
is
physicians,
other
social
workers
who
have
appropriate
qualifications
or,
very
importantly,
law
enforcement
officers
themselves
upon
recognition
of
a
psychiatric
emergency
in
the
community.
By
one
of
these
individuals,
a
person
can
be
detained
until
which
time
they
are
arrive
at
a
psychiatric
hospital
to
then
undergo.
That
second
opinion,
on
their
condition
to
understand
whether
or
not
involuntary
commitment
is
appropriate.
That
second
piece
is
what
we're
discussing
today,
chairman.
B
B
B
B
I'm
I've
got
a
I've,
got
a
I'm
having
a
lot
of
trouble
with
this
to
take
someone's
freedom
away,
even
if
it
is
just
for
for
24
hours
when
the
individual
is
seeking
help
voluntarily
seeking
help,
but
he's
involuntarily
apprehended,
even
if
it
is
just
for
a
short
period
of
time,
and
then
it
affects
the
rest
of
his
life.
It
affects
his
is
right
to
own
guns.
B
It
affects
his
whatever
the
case
may
be
his
his
job
history,
his
his
relationships
after
that,
and
I
I
have
a
real
strong,
I'm
not
gonna,
be
able
to
support
this
bill.
But
thank
you,
mr
dr.
L
Yes,
thank
you,
sir,
for
making
those
very
valid
points.
A
individual
who
is
seeking
voluntary
treatment
would
not
be
impacted
by
this
bill
and
they
would
be
allowed
into
the
hospital
on
their
own
accord.
This
would
address
people
who
are
being
involuntarily
commitment
stating
that
they
do
not
wish
to
be
in
a
psychiatric
institution
but,
however,
that
outside
provider
and
us
in
the
hospital
may
come
to
the
agreements
that
that
is
appropriate,
and
so
that
is
part
of
that
challenge.
B
Yes,
just
a
clarification
on
on
the
removal
of
an
individual's
rights.
It
is
my
understanding
that
the
the
second
signature
to
admit
someone
to
a
mental
health
facility
under
this
title
does
not
take
away
those
rights.
Those
rights
are
only
forfeited
under
a
court
order
which
happens
within
72
hours
to
continue
that
involuntary
admission,
and
so
once
the
judge
is
involved
is
when
that
happens.
It
is
my
understanding
that
not
the
signature
of
a
medical
professional
actually
causes
that
to
happen.
J
Thank
you,
mr
chairman.
Thank
you,
gentlemen.
I
think
resident
hall
addressed
the
matter.
It's
a
staffing
issue,
so
a
person
has
an
emotional
breakdown
or
has
a
psychiatric
condition.
They
are
brought
to
a
facility
or
a
hospital,
and
they
are
at
first
they
are
evaluated
by
a
physician
or
another
professional
who
will
evaluate
them
at
the
first.
J
J
L
J
You
so
they
have
been
evaluated
there
and
a
physician
has
signed
off
on
the
fact
that
this
person
needs
to
be
further
evaluated
but
held
at
that
time.
Then
they're
at
your
facility,
and
it
is
necessary
for
a
second
professional
to
sign
off
on
it
to
hold
them
under
involuntary
commitment
for
whatever
period
of
time
is
necessary,
and
what
you're
saying
is
that
that
second
individual
does
not
have
to
be
a
psychiatrist.
J
Kindly
tell
me
the
qualifications
of
the
second
person
signing
off.
You
said
psychiatric
nurse
now
or
nurse
practitioner
nurse
practitioner
is
an
rn
with
one
to
two
years
of
further
training
to
make
them
nurse
practitioner
now.
Have
they
also
had
additional
psych
nursing
training,
and
is
there
a
certification
for
psych
nurses?
Dr.
A
A
We
have
chairman
jernigan,
I
let
me
take
just
a
moment.
I
want
to
introduce
dr
joseph
sharp,
if
you
would
introduce
yourself.
Yes,.
E
E
I
currently
serve
as
the
chief
medical
officer
of
ascension,
st
thomas
behavioral
health
hospital,
and
I'm
also
the
psychiatric
medical
director
for
st
thomas
midtown
and
west,
where
I
supervise
psychiatric
nurse
practitioners
as
tennessee
continues
to
see
a
growing
need
for
mental
health
services,
combined
with
a
shortage
of
psychiatric
providers.
A
perfect
storm
is
emerging.
E
This
becomes
more
burdensome
when
there
are
two
three
four
or
more
such
evaluations
needed
overnight,
which
the
psychiatrist
is
required
to
do
the
same
fatigued
psychiatrist.
That
will
then
need
to
see
20
to
25
patients
the
next
day
making
critical
life
and
death
decisions
regarding
pharmacotherapy,
neuromodulation
or
even
placement
issues.
E
Qualified
psychiatric
nurse
practitioners
and
physicians
assistants
currently
are
able
to
make
the
above
determination
and
complete
the
first
set
of
644
committal
papers
under
proper
supervision.
It
only
makes
sense
to
me
that
these
physician
extenders
should
be
allowed
to
complete
the
second
set
of
6404
committal
papers
again
with
proper
supervision.
A
We've
reached
our
three
minutes.
You
want
to
close
yes,
sir
quickly.
E
I
just
also
want
to
explain
that
the
bill
would
not
intrude
or
infringe
or
detract
in
any
way
from
the
autonomy
of
the
psychiatrist,
but
instead
would
improve
the
timeliness
and
efficiency
and
workload
distribution.
Okay,.
A
I
Yes,
thank
you
all
for
for
being
here
and
I
I
I
grasp
I
think.
What's
going
on
and
and
so
the
the
first
signature
we
go
and
it's
we
get
to
the
second
signature.
This
is
a
qualified
person
in
mental
health
and
I
think
where
I
I
think
that
I
lean
in
favor
of
this
bill
and
the
question
I
want
to
ask
you
is:
are
there
things
within
those
24
hours
that
that
second
person
can
help
facilitate.
A
I
A
Sense
choose
somebody.
Yes,
dr
sharp.
E
Yes,
so
that,
actually,
that
circling
back
in
24
hours
does
allow
for
more
time
to
gather
collateral
information
while
establishing
the
safety
for
the
patient.
Patients
in
this
scenario
are
kept
in
a
a
waiting
room
that
may
or
may
not
be
very
comfortable
and
they're
in
a
strange
place.
E
E
I
That
part,
I
think,
representative
hall,
was
talking
about
someone
who
voluntarily
comes
in
and
they
they
come
in.
Maybe
they've
had
some
sort
of
panic
attack
or
whatever
they
come
in
and
and
the
first
person
I
guess
to
sign
off,
because
I
guess
during
the
interview,
maybe
they
say
some
alarming
things
that
are
harmed
to
themselves
or
to
others
which
triggers
okay,
it's
not
safe
for
this
person
to
go
back
outside.
So
that
would
be
the
first
signature.
I
And
then
I
love
the
second
aspect,
and
I
do
think
out
of
the
two
signatures
a
doctor:
does
a
psychiatrist
doesn't
even
be
involved
and
what
I'm
hearing
they
are
involved.
Correct,
we're
just
giving,
I
think,
comfort
and
aid
in
those
24
hours
of
someone,
because
it's
based
on
medical
evidence
that
you're
seeing
in
real
time
correct.
I
A
B
B
They
don't
want
to
be
there,
but
when
they
get
there,
there's
a
qualified
physicians,
assistant
or
nurse
practitioner
that
could
that
you
all
are
saying
could
let
them
in,
but
what
the
other
side's
saying
is
they
want
them
to
have
a
a
doctor
to
sign
for
them
to
come
in.
Does
the
doctor
approve
this
by
telephone
or
the
doctor
come
in
and
actually
see
him?
Dr
sharp.
E
So
that
is
usually
done
by
telephone
and
video.
It's
a
video
call
in
the
middle
of
the
night,
which
can
vary
in
quality
as
we've
all
seen
with
the
internet
and
glitchiness.
That
can
happen.
What
this
bill
is
would
help
provide
is
a
real
person
that
is
there
when
the
patient
arrives,
to
address
the
questions
being
asked
and
under
the
direct
supervision
of
a
psychiatrist.
E
B
E
A
For
the
comments
or
questions
of
our
witnesses,
if
none
sir,
we
will,
we
appreciate
your
attendance
here,
appreciate
the
information
and
we
have
a
request
from
a
committee
member
to
have
further
testimony
from
the
tennessee
medical
association.
A
Our
our
good
friend,
julie,
griffith,
says:
come
over
you're
welcome
to
come
forward
with
your
expert
and
identify
yourselves.
You
will
have
three
minutes
as
well.
M
If
it
would
be
okay
with
the
committee,
I
would
really
rather
dr
matthews
testify.
First,
I
think
that
his
testimony
will
be
probably
most
valuable,
but
then
I
want
to
just
put
some
bugs
in
your
ear
after
he
has.
He
has
completed
his
testimony.
N
Mr
chairman,
sir
honorable
members
of
the
state
health
committee
good
afternoon
to
you,
I'm
dr
george
matthews,
I'm
a
hospital
psychiatrist
who
regularly
takes
call
at
one
of
the
largest
psychiatric
facilities
in
tennessee.
I'm
also
the
president
of
the
tennessee
psychiatric
association,
and
I
thank
you
for
this
opportunity
to
speak
to
you
in
opposition
of
house
bill.
2250.
N
N
So
I
want
to
argue
against
that.
Let
me
draw
a
quick
parallel
for
you.
As
honorable
representatives
of
the
tennessee
house,
you
sign
documents
regularly
and
once
your
signature
gets
on
the
document,
that
document
has
gravitas
that
weight
that
the
document
has
is
because
of
the
signature
authority
that
is
invested
in
each
of
you
suppose.
A
bill
was
presented
stating
that
gosh
there
are
fewer
than
100
state
representatives
in
tennessee,
and
there
are
so
many
bills
to
be
passed,
and
all
of
you
are
so
busy,
and
all
of
you
could
do
with
some
rest.
N
N
N
Yes,
I
want
to
state
that
this
bill
does
not
affect
the
service
to
the
patient,
which
is
our
primary
concern,
and
it's
much
more
likely
that
the
patient
gets
attention.
If
a
psychiatrist
were
to
interview
this
patient
before
admission,
then
is
allowed
to
wait
for
24
hours
to
see
the
patient
after
they
are
admitted.
Yes,
sir.
A
Dr
terry,
you
want
to
be
recognized.
You
have
a
question,
then
I'll,
let
I'll
let
ms
griffin
put
her
bugs
in
our
ears.
M
It
required
two
signatures
from
a
physician,
one
on
the
front
end
and
one
on
the
back
end,
and
it
wasn't.
It
was
agreed
upon
years
ago.
We
would
allow
for
there
to
be
a
physician
on
the
front
end
or
a
designated
individual,
which
could
be
a
physician,
but
it
could
be
a
nurse
practitioner
or
physician
assistant
or
it
could
be
a
crisis
counselor
to
sign
that
first
signature.
M
So
then,
on
the
back
end,
you
would
get
that
physician's
signature
now
we're
back
here
to
eliminate
the
second
signature.
Now
I
know
that
there's
a
24-hour
window
in
which
that
physician
would
have
to
come
in
and
see
that
patient,
but
the
problem
is
is
once
that.
Second
second
signature
goes
on
there.
M
M
If
you
are
ever
asked,
if
you
are
going
to
be,
if
you've
been
involuntary
committed,
you're
gonna
have
to
say
yes
you're
in
a
divorce
proceeding,
you
are
in
a
fight
with
your
for
your
children
that
could
carry
with
you
for
the
rest
of
your
life
and
a
physician
didn't
in,
and
even
if
the
physician
comes
in
within
that
24
hours
and
says
no,
I
do
not
believe
that
they
should
have
been
committed.
M
C
Thank
you
and
appreciate
your
comments
on
this,
and
so,
and
I
kind
of
likened
this
a
lot
to
the
way
that
you
presented
it
there
to
him
tala
and
you're
transferring
and
so
on
one
end
what
you
said
doesn't
have
to
be
a
physician,
but
you
are
going
to
a
higher
level
of
care
and
at
that
higher
level
of
care,
you
are
extracting
freedom
and
liberty
from
that
individual
and
that
higher
level
of
care
needs
to
be
a
doctor
in
in,
in
my
opinion,
a
question
for
dr
matthews:
have
you
ever
been
called
or
to
be
asked
to
be
on
call
at
night
and
ever
not
taking
it?
C
Right,
thank
you.
I
just
like
to
give
you
guys
a
cause.
I
think
most
of
the
people
out
there
in
the
committee
know
that
I
usually
I
have
a
process
sheet
for
this
and
the
very
the
process.
The
first
thing
is:
what's
the
premise
or
what's
the
problem
that
we're
addressing
and
and
it
appears
that
the
premise
or
they're
looking
at
potentially
is
there
a
shortage?
Is
there?
What
is
the
need?
Would
you
address
what
that
premise
would
be.
N
Matthews,
yes,
there
is
a
relative
shortage
of
psychiatrists
and
we
welcome
the
addition
of
nurse
practitioners
and
physician
assistants
to
the
team
that
helps
serve
our
patients.
The
issue
here
is
whether
they
should
have
that
signature
authority
for
involuntary
commitment
when
they
first
present
to
the
hospital.
Ms.
A
M
To
me,
in
my
opinion,
if
we're
having
situations
where
you
have
employed
physicians
or
contracted
physicians,
who
are
partly
in
their
contracts
or
in
their
employment
agreements,
have
said
they
are
going
to
take
call,
and
they
are
not
doing
so
within
a
timely
manner.
To
me,
that's
a
that's
a
problem
for
the
employer
to
be
putting
pressure
on
their
employees,
not
bringing
something
to
the
general
assembly
and
asking
the
general
assembly.
Well,
let
me
not
have
to
be
mean
to
my
doctor
and
you
all
just
fix
it
by
taking
people's
liberties
away.
That's
the
way.
M
A
C
Number
two
on
that
list
is
what
are
our
goals
and
to
me,
obviously,
is
to
treat
the
patient
ensure
that
they
do
no
harm
to
ensure
that
there's
no
harm
done
to
that
patient,
but
I
would
also
submit
that
protecting
their
freedom,
protecting
their
liberty,
ensuring
that,
if
you
are
going
to
involuntarily,
commit
them
that
those
processes
that
there's
somebody
there
a
physician's
signature
on
that,
and
I
would
like
to
point
out
that
when
we
have
emergency
surgery
and
the
patient
is
either
out
of
it
on
one
end,
I
have
the
surgeon,
sign
the
consent,
and
then
I
sign
the
consent,
and
so
we
both
sign
the
surgical
consent
and
the
anesthetic
consent,
because
we're
about
to
to
cut
a
patient
open,
and
we
that's
something
that
if
I
mean
I
take
that
very
personal-
that
that,
if
you're
going
to
extract
something
from
a
patient
that
you
need
to
have
that
level
of
care.
C
So
then
that
gets
the
third
thing.
What
are
our
options?
You
say
there
are
other
options
potentially
out
there.
I
would
submit
that
this
option
does
not
meet
all
those
goals
that
I
would
like
it
to
make,
but
thank
you
for
discussing.
Yes,.
A
Sir,
and
let
me
take
a
moment
here-
we
are
out
of
time,
however,
representative
freeman
had
asked
to
be
recognized.
Is
there
a
will
of
the
committee
to
go
back
into
session
and
vote
on
this
issue,
or
do
you
want
to
extend
it
to
the
next
meeting.
A
Questions
of
the
testimony,
if
not,
we
will,
if
there's
no
objections,
we'll
go
back
into
session.
Oh
yes,
pardon
me!
Yes,
go
ahead
quickly,.
O
Thank
you,
chairman
and,
and
the
the
I
appreciated
hearing
my
colleagues
comments
about
the
process,
because,
because
I
have
a
similar
one
and
and
sometimes
I
feel
like,
we
hear
squabbles
between
administrative
level,
that
is
not
necessarily
best
for
for
patient
care,
and
my
question
is
what
happens
today
if
there
isn't
that
second
physician
to
sign
is
that
person
released
even
if
they're
believed
and
brought
in,
because
they
feel
like
they're
a
danger
to
themselves?
N
All
of
the
psychiatric
facilities
to
which
a
patient
may
be
involuntarily
admitted,
does
have
psychiatrists
on
staff
and
does
have
psychiatrists
on
call
24
7..
So
there
is
a
psychiatrist
available.
The
question
that,
or
the
suggestion
here
is:
let's
have
somebody
else,
do
the
second
certification,
while
the
psychiatrist
gets
to
rest,
I'm
a
psychiatrist
who
until
recently
took
call
two
nights
a
week
and
I
want
to
say
that
it
is
being
done
and
it
is
being
done
adequately,
but
this
is
again
an
attempt
to
undermine
that
signature
authority.
A
I
think
does
that
answer
your
question.
I
think
the
representative
is
satisfied
and
do
we
have
further
comments
or
questions
of
our
testimony
witnesses.
If
none
we
will
go
back
into
session.
Thank
you
so
much
for
your
information.
You
shared
with
us
we're
back
in
session
and
we
will
recognize
chairman
hall.
B
Thank
you,
mr
chairman.
It
it
seems
that
there's
a
lot
of
unknowns
and
there's
a
lot
of
unanswered
questions.
I
would
like
to
just
to
respectfully
ask
the
sponsor
from
shelby
county,
to
withdraw
this
bill
and
send
it
to
summer
study
and
then
revisit
it
on
another
day.
Are
you.
A
Making
that
as
a
motion,
yes,
sir,
we've
had
a
motion
to
refer
to
summer
study
I'll
recognize
chairman
vaughan.
H
Well,
I
didn't
know
that
that
was
that
I
got
a
chance
to
withdraw
it
if
it's
being
motioned
to
go
to
summer
study,
but
here's
I
think
it's.
I
think
it's
kind
of
fascinating
conversation
that
we've
had
here
today.
You
have
operators
of
facilities
that
see
real
live
patient
people
in
distress
versus
and
I'm
usually
a
a
tma.
H
I
agree
with
tma
on
more
issues
than
not,
but
I
find
the
tma
in
the
middle
of
a
turf
battle
and
saying
that
people
can
be
examined
over
an
iphone
and
it's
equivalent
to
having
another
human
being
in
the
room
with
them
make
a
a
reasonable
decision
on
it.
So
I'm
obviously
I
stand
at
the
will
of
the
committee.
I
I'm
at
this
point
in
time.
Withdrawing
the
bill
kills
the
bill.
So
I'd
just
assume
the
committee
vote
on
it.
Okay,.
A
Do
we
have
a
second
on
that
motion
chairman
terry
makes
the
second
any
discussion
or
comments,
if
not
we'll
be
voting
to
send
this
bill
to
summer
study,
all
those
in
favor
say
aye
all
right,
any
opposition
so
approved
all
right.
Thank
you.
Thank
you,
sir.
We
will
stand
for
a
motion
to
adjourn
the.
The
remaining
balance
of
the
bills
will
be
rolled
till
next
week's
calendar.