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Senate | April 10, 2013 | Committee Room | Senate Healthcare

Full MP3 Audio File

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Thank you, Mr. Chair. Thank you, Senator Brock. You know this is a very serious subject, and something that our state, I believe, has been missing out on to, much to the distress of a lot of parents who suddenly get home with what they, with a new bundle of joy from the hospital, and suddenly find out that the child has a very serious disease. It's something that has to be done right away. And this would go a long ways towards helping us prevent these bad outcomes. So, I received an email Monday from a gentleman who happens to be in the audience today at my invitation. And he was writing to me to concerning Senate Bill 98. And he says that it was very important to him and his family, because his daughter, Grace, required open heart surgery after 18 weeks of life. And so, this issue is very important to him and his family. And I would like to introduce to you Eric Sanchez, and his daughter Grace. And if they would just step out in front of the door here, so that everyone can see them. Grace is now five years old, no seven years old, I believe now, in second grade. They live over in Durham. And you can see she is the picture of health, but she had to have open heart surgery at age of 18 weeks. And so, this young lady is what we want. We want healthy young ladies to come up, and we do not want them to have to go through all of this episode. So, this will go a long ways towards determining that, and allowing perhaps less invasive procedures to take place in the future. So, thank you very much, Eric and Grace, for coming over here today, and I would certainly. Mr. Chair, if you would recognize Senator Davis, who brought in all of these pages with him today, I would appreciate it very much. SPEAKER CHANGES: Okay. With that motion just say again. And thank you very much for being here today and being involved in this issue. I appreciate it. Senator Tucker, you wanted to speak. SPEAKER CHANGES: Thank you, Mr. Chair. I too applaud Senator Brock and Peyton Stein for bringing this forward. No physical impact, but the outcome can be so positive. I also want to recognize tight end for the Carolina Panthers, Greg Landry, whose son, I mean Greg Olson, who, I'm sorry, I went back to the Cowboys, Greg Olson and his family for the efforts they've made in using his notoriety to bring attention to this bill. His son too has faced three surgeries now, I believe, and certainly hope that that outcome will continue to be positive, like little miss Grace. So, I just really appreciate you guys taking the time to get it done, and get it on through, and let's get about it. Thank you sir. SPEAKER CHANGES: Appreciate it very much. Senator Barefoot. SPEAKER CHANGES: I'd like to echo all the same comments, but also point out that four months ago today, about three hours from now, my son was born. And they did the pulse ox test at WakeMed Cary before he left the hospital. Took about two minutes. Strapped a little thing to his foot. I even took a picture of it, because I follow the Child Fatality Task Force, and I knew this bill was going to be coming before us this year. And it was so simple. It was so easy. And I just commend you for doing this. Thank you. SPEAKER CHANGES: Thank you. Senator Robinson. SPEAKER CHANGES: Thank you, Mr. Chair, and thank you Senator Brock, and the others, because you know how passionate I am about health care and about preventative health care. And I was around during the time we did a lot of the pieces for genetic screening to, as a preventative tool, and this is another one. And so, I think it's so important that we do these kinds of things to make sure we're on the prevention end, so our children can have fuller lives. So, thank you so very much. SPEAKER CHANGES: Thank you. Senator Allran. SPEAKER CHANGES: Thank you. Quickly, I reiterate all the positive things that everybody has said, but I do want to ask one other thing. I wondered if staff, or the bill sponsors, happen to have information on all, or estimates of all the money that we will save by doing this?

Do we have estimates of that? [SPEAKER CHANGES] No, I do not believe we have a fiscal note yet. We're kind of waiting on that process. [SPEAKER CHANGES] Well, I'm talking about the money that will be save because we do this. It would be, I think, helpful or good to have that. [SPEAKER CHANGES] Mr. Chair. [SPEAKER CHANGES] Okay. [SPEAKER CHANGES] Mr. Chair. Denise Thomas, Fiscal Research. Senator Allran, we did do a fiscal [inaudible] usually as part of the fiscal note process were not able to measure savings of that type, but if you like we can try to work with the department and get an estimate. [SPEAKER CHANGES] If it's not too much trouble, I think it would be a nice thing to be able to add to all the other positive comments. [SPEAKER CHANGES] If I could just answer. Senator Allran, I know there was a national figure of how much this would save national cost. An estimate and it was way up therein billions of dollars. Actually I was able to witness two heart surgeries my first month in office over at Bender's[?] children hospital at Baptist or Wake Forest or whatever they changed their name this week to. It was actually two children from my district from Salisbury, and it just happen that both were having heart surgery at the same time. The amount of money it would take for that surgery and the personnel that were there. This would save a lot of money for nationwide, but I don't have the exact figure for North Carolina. [SPEAKER CHANGES] Senator Jim Davis. [SPEAKER CHANGES] Thank you, Mr. Chairman. Is there a position that we have from the Pediatrics Society about this bill? [SPEAKER CHANGES] Yes, we do have some people in the audience that are willing to speak on this. [SPEAKER CHANGES] Recognize Dr. Morris. [SPEAKER CHANGES] Past president of Pediatrics Society and I spoke this morning with our current present and executive director and we support this bill. We support this bill going forward. It is the recommendation of the American Academy of Pediatrics to do newborn screening with pulse oximetry. [SPEAKER CHANGES] Senator Kinnaird. [SPEAKER CHANGES] Thank you, Mr. Chair. It seems to me that either the pediatricians who just spoke or even the family could just say what their one operation cost. I would think that that figure would be right there. That would be a cost estimate right there. [SPEAKER CHANGES] Would you like to speak, sir? [SPEAKER CHANGES] Sure. My name is Eric Sanchez. I'm not sure I heard the full question. How much the surgery cost? [SPEAKER CHANGES] Senator Kinnaird. [SPEAKER CHANGES] Grace's surgery was well north of about two hundred thousand dollars, but to the point about what's saved. It would be akin to you breaking down on the freeway and then having to get a tow truck to take your car to an auto body person and then going through that diagnostic versus I think as Senator Barefoot said, it takes a second to get it done. The infrastructure is there. It's a heck of a lot quicker than finding parking in downtown Raleigh and certainly cheaper. [SPEAKER CHANGES] [Laughter] Thank you. We have a motion from Senator Don Davis for favorable report to the bill. Any other comments? [brief pause] Hearing none. All those in favor of the bill before us say aye. [SPEAKER CHANGES] [chorus] Aye. [SPEAKER CHANGES] Opposed no. [SPEAKER CHANGES] [silence] The ayes have it. Thank you. [SPEAKER CHANGES] Thank you members of the committee. Mr Chairman, thank you. [SPEAKER CHANGES] Members of the committee we will now move to Senate Bill 456. Designate Primary Stroke Centers. Senator Pate. [SPEAKER CHANGES] [inaudible] ...we have a PCS for this bill. Senator Pate moves for the adoption of the PCS to his bill. All those in favor say aye. [SPEAKER CHANGES] [chorus] Aye. [SPEAKER CHANGES] Opposed. [brief pause] The ayes have it. Thank you. Senator Pate. [SPEAKER CHANGES] Thank you, Mr. Chairman. This bill comes at the recommendation of the Justus- Warren Heart Disease and Stroke Prevention Task Force and there are some people on that task force who really have the health of our population in mind and I've received quite an education from them and it's a delight to serve with them on that task force. Stroke is very prevalent in North Carolina, especially eastern North Carolina. We seem to be the belt of the area in which stroke is likely to happen to our citizens. I don't know if it's because of all the good BBQ and collards, but the eastern part of the state is very prominent. [inaudible crosstalk] Fatback, is that what is was, Senator Woodard? Okay. Thank you for that culinary bit of information.

chart available and I wish I had had it printed up so you could all see it today but we have primary stroke centers in the state. I think there's something like 20 or so that are in our state but if you take a look at a map of North Carolina the concentration of the primary stroke centers is down the I-85 corridor from the northern part of the State down through Charlotte. In the eastern part of the state where as I just mentioned the belt of the stroke area is located we have one primary stroke center. And in the western part of the state I believe there's just one as well and so the concentration is in the Piedmont as is the concentration of population. However, that does not address the needs of the eastern part of the state nor the western part of the state and so hospitals that want to undertake the work that is necessary to become listed as a primary stroke center can do that under this bill and it makes it a little bit easier and if I were to suffer a stroke at my home I would want to go to the primary stroke center. I would think that that's where the rescue people or emergency people would want me to go and my family would certainly want me to go there and if a hospital brings itself, a medical center brings itself to the point of being a primary stroke center then the word would get out, the Health and Human Services Department would be responsible under this bill to disseminate that information to all medical people throughout the state once a year that these are the places to go if a victim suffers a stroke and if it's diagnosed. So this bill directs the Department of Health and Human Services to designate qualified hospitals as a primary stroke center. A hospital that wants to do this can be accredited by the Joint Commission and they can present themselves to that grade of stroke center and become a primary stroke center and that would be the destinations in our state for stroke sufferers under this bill. I would appreciate your support. [SPEAKER CHANGES] Senator Robinson. [SPEAKER CHANGES] Thank you Mr. Chair and I certainly move for a favorable report at a proper time but I wanted to just make a little comment, Senator Pate. As a little aside, when you talk about our way of eating I want to comment. Senator Tucker when I see you in the cafeteria downstairs you need to be careful of the salt. I try to make that an issue with a lot of people because of the way the food is salted, etc., that also has some impact on what we do. [SPEAKER CHANGES] Senator Tucker. [SPEAKER CHANGES] May I respond to that? Senator Robinson if I wanted to listen to a comment like that I could just go home and listen to my wife. You don't need to take her place while I'm here. [SPEAKER CHANGES] Do you have other comments Senator Tucker? Did you want to speak? [SPEAKER CHANGES] Senator Pate thank you for bringing this forward. It's a very expensive process to become a primary stroke center for most hospitals as I understand it and of course those that are primary stroke centers have gone through ?? Joint Commission and had this certification. Is there any additional expense to those hospitals that are already primary stroke centers as a result of this bill or is it just establishing criteria to move forward with stroke centers for designation? I don't know that like a rural hospital would have to go to a lot of expense down the eastern part of the state to become a stroke center. Although we'd love for them to do that but just kind of those expenses there, sir, if you could expound on that. [SPEAKER CHANGES] I don't believe any of the existing primary stroke centers would incur any more fiscal responsibility. Now the ones who want to upgrade themselves to this, yes, there would be expense. I have requested a fiscal note. Have not yet received it. That was my fault because I just requested it yesterday. I thought maybe we did need to take more of a look at it but I do not yet have a fiscal note on that. [SPEAKER CHANGES] Thank you Senator Pate. Thank you Chair.

I'll get-right now I have four other people scheduled to speak. I'll give you over to Parmon, Don Davis, Senator Stein, and Jim Davis. I'll give you ??? coming up. Senator Parmon. [SPEAKER CHANGES] Thank you, Mr. Chairman, and I, too, want to commend this sponsor for bringing this bill forth. About two weeks ago I had the unfortunate experience of presenting myself at one of the local stroke centers with stroke symptoms and I was very pleased that the providers there were trained specifically to look for and to treat those symptoms, and so I know how important that is and I also know and hope we encourage hospitals (??) in the western parts of the state and the eastern part of state, even though it may be some expense to our ??. It's very important for our citizens and for us to have to train providers to treat presenting with those symptoms. [SPEAKER CHANGES] Senator Don Davis. [SPEAKER CHANGES] Actually, I just wanted to commend the work of the task force, the bill sponsors. This is very important down east and actually across the state, so thank you again for bringing it forward. [SPEAKER CHANGES] Senator Stein. [SPEAKER CHANGES] Thank you, Mr. Chair. I am a big proponent of truth in representation, so I think the only hospitals that are actually truly primary stroke centers should be able to call themselves primary stroke centers, and so my question is is it a problem when some have been claiming to be a stroke center when they don't meet as joint commission designation? [SPEAKER CHANGES] Senator Pate. [SPEAKER CHANGES] I have not had any information concerning that. I don't know that- the ones that report to be primary stroke centers I believe had met all the requirements. I'm not sure of any that have been deleted from that. Mr. Chairman, if you would like to recognize someone from the Justice Warren task force, she is available and ready, Peg O'Connell. [SPEAKER CHANGES] Miss O'Connell. [SPEAKER CHANGES] Thank you, Mr. Chair and Senator Pate. Senator Pate, I have your maps, sorry I didn't give them to you. I am a member of Justice Warren's heart disease and stroke prevention task force representing the American Heart Association and the wife of a man who died of a massive stroke, actually right here, on this floor in this building four years ago. We have not found evidence and have there's no intent to accuse any hospital in North Carolina of holding themselves out as a primary stroke center when they are not, but we have, in other states, seen places that have tried to hold themselves out. So we want to make sure that that does not happen in North Carolina. The people who go through the process of becoming primary stroke center designated by the joint commission do a lot of work at a lot of expense. We want the public and EMS to know where to take people who have strokes or exhibit the symptoms and signs of stroke, and to make sure they get the care as quickly as possible because we like to say time is brain, and if you're waiting for a neurologist to come or someone to find the right medicine, there's more and more damage that happens to a stroke victim. [SPEAKER CHANGES] Senator Jim Davis. [SPEAKER CHANGES] Thank you, Mr. Chairman. Sort of along the same line as Senator Stein talking about these hospitals, would it be unreasonable for us to require a hospital to direct us to the nearest stroke center if they are not one? [SPEAKER CHANGES] That's part of the bill, Senator Davis. I believe that they're going to require- maybe staff could help me out on this, but I believe transportation of acute stroke patients to the primary stroke center would be required under this bill, and the acceptance by the stroke center of acute stroke patients initially treated at hospitals not capable of providing the appropriate stroke care. So if someone presents at a hospital that is not a primary stroke center, they would immediately be transmitted over after they have received the appropriate care that that hospital can give them, they would send them over to the nearest primary stroke center. [SPEAKER CHANGES] Follow up, please, Mr. Chairman? I probably asked my question in the wrong way. It says here in page 2, line 4-

Now the department shall maintain the division of health service regulation, the office of emergency service the list of the hospitals. When you're in Swayne County or Graham County you're probably not going to look at that website. You're going to look at your closest hospital. So my question is, if I go look for my closest hospital (mine would be Angel Medical Center)would it be unreasonable to expect them to have on their website whether they are a primary stroke center or direct me to the nearest one by going to my hospital website and not this one that I may not even know this exists in the state. SPEAKER CHANGES So somewhere in the bill it says that the department is going to inform all health providers and offices throughout the state a list of where the primary stroke centers are and so if you present to a physician. SPEAKER CHANGES We may have someone who wants to comment on this further. It is my understanding that you should report to the nearest health center first to receive a certain amount of stabilization care and others that should be done in emergency situations immediately at the closest possible place. It is the stroke center we would move to and I don't know if someone wants to speak to that, but it's been on other conversations. SPEAKER CHANGES Cody Hann from the hospital association speaking. Senator Davis, our hospitals work with our emergency service [providers to develop the protocols so that when they get a call they can correctly place the person at the right facility. Also, most of our hospitals are equipped so if someone comes to our emergency department without emergency transport to get that patient stabilized enough to get them to a stroke center. SPEAKER CHANGES That answers my question. Probably what we ought to do is tell everyone that if you know somebody who has one give them half a dozen aspirin. SPEAKER CHANGES Yes, Mr. Chair, question, and I'm a little confused. First question is the only hospitals tahts can be a primary stroke center as recognized (designated) as a PCS have to hold a JCO certification as such. SPEAKER CHANGES Yes that is correct. SPEAKER CHANGES Alright then here's the question and I don't know if I'm reading this right right...it says if you hold a JCO cert as a PCS I get that. Second is I'm designated on the DHH's website as such. Now if I drop to section 1 second back page lines 9-11, item D, if I'm not on the website but I'm certified by the federal government as a PCS but I'm not on the website I can't advertise that I'm such? I don't think we want that to happen. Am I misreading this or..? SPEAKER CHANGES ?? What would happen is that a hospital in North Carolina licensed in North Carolina would not be able to advertise or hold itself out as a primary stroke center unless, you are correct, unless the department had designated them as a primary stroke center which is what the department should automatically do once they submit the form showing they have the joint commission accreditation. SPEAKER CHANGES Follow up, I'm not sure we want to tell UNC hospital or Carolinas or any of our tertiary academic medical centers that if we got a delay because it's not posted on the website that they can't advertise or tell people they're a primary stroke center.I think that is not a good position for us to be taking. SPEAKER CHANGES And I apologize its not related to the website it would be the department making the designation so if there was a delay for being posted on the website that would be fine,its just the department would have to designate them as a primary stroke center. I apologize. SPEAKER CHANGES Follow up, then why is DHH overriding federal government and JCO? DHH doesn't have the ability to determine their primary stroke center. So you're saying the DHH has to tell and designate them and until they recognize them they are not a PCS. That's not true.

No, the department is utilizing the joint commissions designation of a primary stroke center as a blanket if JCO accredits them, then the department will recognize them automatically as a primary stroke center. What will apply is the ability to advertise or hold the hospital out. [SPEAKER CHANGES] Final follow up. [SPEAKER CHANGES] Is that the intended consequence we really want to have happen, that hospitals can't advertise even though they're accredited by JCO until DHH designates them as well. [SPEAKER CHANGES] Senator Pate. ?? [SPEAKER CHANGES] Are you talking about the timing between such time as they are certified as a primary stroke center and the time after that that the Department of Health and Human Services gets it on their website? [SPEAKER CHANGES] No, I'm saying, I guess and I'm not sure if I'll be absolutely clear. Let's just use a hard example. Caroline's medical center is a primary stroke center. We're saying until DHS recognizes them as that, they can't advertise in their community or market as such. This is what this is telling me right now if I'm reading this correctly. [SPEAKER CHANGES] I can't think of any major time delay between the time that they are certified and the time that the department knows about it and gets it on their website. [SPEAKER CHANGES] Senator, just to clear it up, I think in this whole conversation, what we're looking at is that we don't want them to go to the media or their advertiser or their publisher and have to prove to them that they have the certifications that they want before they can engage in that advertising. What we're saying is that they will go to the department, show that they have that certification, the department would then authorize them as, designate them, and they would be able to advertise or to move forward. I think that's, I don't know if that's kind of the summary that's going to but maybe [??] will help us out with that. [SPEAKER CHANGES] Chairman, if I may add, the bill becomes effective October 1, I think in part so that hospitals that are primary stroke center certified now have time to get all that settled with DHHS before this would then take effect. [SPEAKER CHANGES] Senator Rabin. [SPEAKER CHANGES] Thank you. I'm thinking from what I've heard that we have a geographic disparity as well as other things that happened. And this bill being voluntary doesn't necessarily fix the geographic problem if people don't want to volunteer or fail to volunteer or don't think they're qualified to volunteer. I support the bill, but we might want to consider a way to incentivize or draw people in so that the geographic disparity disappears. It's just a suggestion that, I am a victim of a TIA previously and a lot of people don't even know if I've recovered yet or not, but I did have to throw that out just for consideration. [SPEAKER CHANGES] Thank you. Other comments. Hearing none, I believe Senator Robinson had moved for a favorable report. Senator Davis? Ready to move? So, okay. All, move for a favorable report for the proposed committee substitute, unfavorable as to the original bill. All those members in favor will say aye. Opposed no. The ayes have it. Thank you members of the committee. We will, I'm assuming the LMECO and early grievance process will be coming again at a future meeting very soon. As amicable as it is, maybe we should try to run it in at the last moment, but that's okay. Moving forward, but we've got some work to do on that one. So having exhausted the agenda, we will stand adjourned.