Members and visitors if you will take your seats this time we'll call this meeting and my house committee of health to order. Our sergeant AT arms today are Mr. Young Bay, Mr. Bill Morris and Mr. Jim Moran. Thank you gentlemen. We also have some pages with us today, and he would stand when I see at least one page and maybe the second one here, Catelyn Ivory from [xx] counties sponsored by representative Suzan Martin, about Philip Amentrao from Craven county, and he's sponsored by representative John Bale, welcome to the house health committee. Members we have one item on our agenda today, It's house bill 796. Representative Brian Brown, representative Brown, there is PCS and without objection the proposed committee service will be reinforced representative Brown your recognized to present the bill members I'll be brief in this very important bill but essentially this house bill 796 makes amendments to the dietician nutrition the diet nutrition practice act that 10 times first which regulates the new as a new life for dietician and nutritionist when retaining the current is proper representation for the newly created licence nutritionist more licenger and also defined what those individuals were not licensed can't do as well and as well simply modernising with that with that I'll certainly yield for any questions we do have some members from the board and others that can answer very specific questions that you may have regarding these changes but other than that I will yield for your questions. Take questions and comments from members of the committee Representative Wadel. Thank you Mr. Chair and I was happy to say that when we revisited this bill again it didn't have anything to do with the lasting requirements for dietitian, because my daughter is a dietitian and they were passionate about that the last time. Full motion at the proper time. I'll hold that Representative Adcock[sp?]. Well you beat me to it, Representative Wadel I was going to make a submission. I just wanted to say I wanted to commend representative Brown for all the groups he's brought together on this, I understand there's unanimity, on these changes, these are good steps I have three nutritionists on my staff, excellent professionals and they're all in favor of this bill as well. So, thanks very much for bringing it. Thank you Representative Zucker[sp?] Thank you Mr. Chair, I just had a question on the license requirements that seems where both of the changes were made, and am just curious, were they made tougher, looser? I mean could somebody talked to that just generally. I would actually put to [xx] just to ensure that that question is answered answer very clear for you Representative Soccer. If you will state your name and your position for the record and do you hear that question or do you need it repeated? Yes I'm Kim Ails I'm with the North Carolina Dietetic Association and I believe no one need to know if the requirements were made stricter or at least. So, what we did is, we did out of license pathway for the nutritionists, these individuals with our current list law could not be licensed in this state, so, we did open up a pathway for them to be able to have licensor provided that they were able to meet minimal requirements like a degree from an accredited university, certain hours of supervised practice and then an examination and so we cut the standards high in opening up this licencor pathway but did provide another way for folks to be able to become licensed. Follow up Representative Dzeco. Does this bring us more in line with other states so that someone who is moving from North Carolina from another state then it's easier for them to get this license? Ms Ailes[sp?] if you would again please state your name just for the record. Kim Ailes[sp?] with NCDA yes there are other states that do license these individuals, there are fifteen due and then Florida just amended their licencor law to be able to add the two examinations for the nutrition diplomats and the CNS folks as well, and they're working on the same thing in New Mexico and New York. So states are moving in this
direction and it does make it easier for these folks to be able to come here and to be able to practice. Representative Avila, you're recognized. Thank you Mr. Chairman we may have to have these roles back up but my question is, I think everybody in doing their research on this remembers the issue with Mr. Cucksey and the Dietetics Board. And my question is I know in the enforcement part of it what the restrictions are you can't put yourself out as a nutritionist or dietitian or anything of that nature. What is the position of someone who is in the same category I guess of Mr. Cucksey who is not putting himself out, he's just basically telling his story, what worked for him, he doesn't make money on it or anything of that nature. What is the position of the board toward someone like that? Again I'll allow Ms. Lyles to clearly states that but as long as you're not being remunerated for what you're putting out there, you're not liable but again I will let Miss Iyles to find out. Ms. Iles you're recognized to respond. Mr. Jones the attorney for the Board is also here seeking they may be able to [xx] more. and information but in that situation, as long as he, as long as an individual is not holding himself out, as long as they aren't providing specific recommendations towards a deceased state, it would not be issued under this law. Are there further comment or questions? Representative Browly? Mr. Chairman I apologize for being late but there's a question that may have been asked I'd like to have an answer again and I ask the board to indulge unfortunately I've looked at the weight charge in my Doctor's office and it says that I'm obese if I talk to people about diet who don;t have the certification healthy stores fro people who are not buying something [xx] any of that for people who don't have this licence ensure I have heard you say they can charge, but are we saying the only people that can compensated for diet nutrition have to hold this certification? Representative Brown would you like the staff to take that? Sure Ms Johnson your recognized I will call your attention to page 10 line 41 there's some new language there that I think might help it is in the section of person's and practices not affected by the article and an individually who provides nutrition information, guidance, weight control services, things along that line as long as they're not holding themselves out as the licensed dietitian or a licensed nutritionist and they're not providing some sort of medical nutrition therapy which is strictly for the purpose of treating and managing a medical condition then this article would not apply to them at all. Follow up. Follow up. I'm obese that's a medical condition so someone you're not holding themselves out as a licensed anything anything but they're helping me lose weight are they subject to this bill? I would say no you could also differ to the board if they have anything additional to add but no, just generally discussing your weight would not fall under that critical. Other members of the committee questions or comments, representative Bradley you have a follow up coming? Well now, It's just to debate the bill No its just to debate the bill. You recognized debate the bill. We're seeing a lot of Licencor Acts come through, recently a lot of them. People get licensed and then there's some kind of restriction, I would remind the board that a couple of years ago, we had one for locksmiths, and the question was asking the committee, does this mean the guy with the key machine in the hardware store, can't make keys but within, had complaints from hardware stores, that we're getting cease and decease letters from the locksmith's board saying, you are not a licence locksmith, you cant copy keys. So I'm concerned that any time, if we say, that you aren't holding this certification, there's a list of things you can't do and I want it to be made clear that if you're working on something with a prescription, I could see the restriction. But obesity could be defined as a medical condition, and I'm not saying I'm voting against the bill to try to block on the floor, but I'm raising this concern, because unfortunately we've seen this happen too many times in the past. Thank you Mr. Chairman Representative Brown, you're recognized. Thank you Mr. Chairman, thank you representative Brawley and your points are well taken. I kind of talk about this from a personal perspective I suppose, in a former life, and although you don't see it now with this manly structure that I have, but I was a [xx] coach and also a personal trainer, received certifications online
those sort of things, and then upon ending that portion of my career stepped into the medical arena, and dealt directly with nutritionist and by no means and in no way was I anywhere near as qualified as those nutritionists were and as dealing with disease state management and specific needs from a nutritional standpoint certainly I could walk into a gym and assist you with weight reduction and a healthier lifestyle, but when it come to disease state management absolutely no realm of information would I have that would assist you. Mr. Chairman. Representative [xx] I have a question for Staff. Question for Staff you're recognized and, If I remember correctly I believe that there are some services that these licensed nutritionists provide that can be build directly MedicAid, to a health insurance company, and if that's the case I think that's part of the reason they need [xx] is that but it would identify them as someone who could be legally be reimbursed through an insurance company, that's just the question. Ms Jones you're recognized That is correct. Further comments from the committee, ladies and gentlemen this is a committee meeting and not a public hearing, but we have had a member of the the audience that has asked to speak, I'm going to recognize her to speak for a period not to exceed one minute, and then I'm going to open to the audience if there's someone that wants to speak on the opposite view. So, Ms. Ruth M. Foster, you've asked to speak, I would recognize you to speak for period not to exceed one minute if you would like the other speaker just begin by stating your name and if you have a position with any group please say that as well. Good morning, thank you chairman, yes my name is Ruth M. Foster, and I'm opposed to this bill, I am a former nurse and Oren I don't have my license right now, so, I'm also working on my doctorate in Holistic Nutrition not dietetics. I started my doctorate studies and found out that it's illegal for me to practice nutrition in the state of North Carolina. However, I feel I'm very qualified and I don't need and I don't want to become licensed. I'd like clarify this, this licensing board is 2300 something members they are recognized by the academy of Nutrition and Dietetics. They are registered by and credentialed by them, and on the federal level Centers for Medicare Medicaid Services, provides them with the criteria to be in the hospitals and to receive medical insurance reimbursement. They do not need a licensing board, there are lots of states, Fifteen seconds please. Can finish with one thing? I'll give you fifteen seconds please Thank you. The state of New Hampshire recognizes that it is not the job of the legislator to chose one or another nutrition specialist. I think that it's very dangerous, the language of this bill stops me as being a mom, being able to access and work with sick people and my own family and I think that you should really look carefully with this, they are already taken care of on the national level, they are not necessarily here, thank you. You're welcome. And the chair would not I did give you a minute and a half, so we try to be gracious, Representative Brown you're recognized. The only thing that I would say is the comment of saying that this bill keeps on from dealing with for family unless she's asking for her family family to pay her, this does not restrict her from dealing with her family. Ladies and gentlemen to be fair is there member of the audience that is here that would like to speak in favor, if you will please come forward to be recognized. I would also ask you to limit your comments to a minute, and if necessary I'll be gracious with the few extra seconds like I was with the previous speaker, but if you would please state your name and position for the record. Thank you sir. My name is Robin Smith Brown, and I am also with the North Carolina Dietetics Association and I just wanted to take a moment to add a different aspect to this bill, there's been a lot of discussion about general weight loss counselling and the natural parsec ways in that tape and stuff, but there is a piece of nutrition called clinical nutrition, and the centers for Medicare Medicaid services changed their conditions participation effected July of 2014, suggesting that dietitian should be or can be the primary care provider when it comes to nutrition services in the hospital setting, so that's what I'm here to represent. This bill clearly defines order writing for us to include parenteral and enteral nutrition. Enteral nutrition is tooth feeding and is done through a means where you eliminate having used the mouth but can still use other functions of the guide, parental nutrition is done intravenously. Parental nutrition is the combination of Dextrose protein, Magnesium, calcium, sodium et cetera that is, clearly defined and tailored for
a patient based on what their current disease state is. 15 seconds please. OK, it is considered a high risk medication which means that its a medication involved in a high percentage of medication eralds in all central events and medications that carry high risk for abuse areas or other adverse outcomes. Therefore, it's essential if dietitians will be writing his order in the hospital setting in corroboration with physicians, that there is [xx] to support the advanced credential and training that is needed to do so. Thank you very much, and I do want to thank both the speakers. I think you both used your limited time very well, and you both used pretty much exactly the same time, representative Brown, would you like to come in this time? For this discussion further debate. Seeing none, Representative Warde are you recognised for mercy? Thank you Mr. Chair. I'm mood that we give a federal report to house bill 796. Representative Wadeo moves for a favorable report for the house committee substitute for house bill 796 unfavorable to the original. Have I restated your motion well sir? You've heard the motion before you, all those in favor signify by saying "aye" Aye All oppose, "no". The ayes have it and being no further the business before this committee, representative Brown Moment of personal privilege Mr. Chairman You are recognized for a moment of personal privilege. Thank you very much Mr. Chairman. Members, I will draw your attention to miss Amy Johnson today will be her last day as a member of this health committee and as a chairman of this committee we'll greatly miss miss Johnson she's a tremendous asset to this body and a tremendous asset in this committee and I would just ask of us to give a very big round of applause for her service in this body thank you Mr chairman. Thank you Chairman Rams here, but a ram a third will recognize you a will for a point of personal privilege. Thank you Mr. Chairman unfortunate we had a lot extra meeting so little left for time Amy Joe has done a credible job the number of hours she's put in the spotless committee I would even hate to guess, but I've received emails from her late in the night early morning this has been a very, very active committee in the last couple of months so we do really appreciate she's going for another opportunity and we really congratulate her not only the work she's done but the works she's going to continue to do for the state of North Carolina. Thank you Chairman RAm in the back I'll just add a brief comment I just want to thank my fellow chairs and chairman Brown for bringing it to our attention my feeble brain is so tired from this week, I almost failed to recognize that this is our last health meeting with Ms. Johnson but she has done work here and we greatly appreciate the time and effort she's put in and we wish her God's speed in all of her future endeavors, God bless you and ladies and gentlemen with that, the business of the committee being concluded, we stand adjourned.