The Senate Health and Human Services Committee met on June 27 to hear invited and public testimony on the following interim charges:

  • Reviewing the processes for public health data collection and coordination and identifying continuing barriers to dissemination of data concerning health care facility capacity.
  • Examining the impact of state and federal pandemic policies, examining how regulatory guidance impacts the patient-doctor relationship and recommending any changes needed to ensure the development of data-driven guidance during public health emergencies in Texas

A video archive of the hearing can be found here.

 

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Chair Kolkhorst – Impact of covid and response resulted in serious and deadly disruptions to way of life; wisdom and knowledge are essential in crisis; must draw on the lessons we learned from covid and realize what to do differently
  • Students, businesses, and families impacted by covid
  • Campbell – We learned a lot and this review will help us handle the next crisis better
  • Chair Kolkhorst – Campbell and Buckingham were on the front lines and gave critical insight into the pandemic
  • Hall – Since COVID, the government has infiltrated our lives, the government usurped the rights of doctors; this can’t be the norm in the longterm ; federal government policies resulted in more people dying than covid itself

 

Reviewing the processes for public health data collection and coordination and identifying continuing barriers to dissemination of data concerning health care facility capacity.

 

Invited Testimony

Kirk Cole, DSHS

  • Scope and scale of Covid-19 unprecedented; challenged response services
  • Improvements in data collection systems occurred during pandemic; still looking to improve
  • More flexible and scalable systems; need to ensure these systems can be maintained and leveraged
  • Covid-19 required real-time data collection and publishing
  • At the beginning of Covid, data collection methods insufficient
  • Partnered with other departments to gather data
  • Relied heavily on federal funding to improve data collection systems; funds end in July 2024
  • Challenge both insufficient system and variety of data sources that needed to be standardized
  • Before pandemic, could receive 2,000 lab reports each day; now 330,000 a day
  • Shifted manual processes to electronic
  • SB 969 helped support data collection and sharing effort; clarified data collection dissemination efforts for future disasters
  • DSHS working on required reports about data collection to be published later this summer
  • SB 984 clarified hospital reporting expectations; working to make hospital reporting system more adaptable
  • Centers for Medicare & Medicaid Services looking to make Covid hospital reporting permanent
  • Kolkhorst – What would we be reporting?
    • It would include Covid but also about hospital conditions and capacity; we aren’t sure exactly what they would want
  • Perry – Who determines what we are going to track?
    • State and federal government; the federal government tracks data across all states
  • Perry – How was data tied to comorbidity? At what point in the data collection process did reporting focus on comorbidity?
    • Instructions to medical suppliers is to report the underlying condition of the death but they can include other conditions
    • When we count our numbers in Texas, we only include patients whose single underlying condition was Covid
  • Perry – How did you report deaths?
    • The death reporting is electronic
  • Perry – Do you break down death by vaccination status?
    • We track it for fatalities but not hospitalizations
  • Perry – Do we track people who are partially vaccinated? If fully vaccinated is 14 days after, but someone dies of Covid on the 13th day would it be showed as a complication due to vaccine?
    • We wouldn’t unless a medical practitioner reports it that way
  • Perry – Do you know what the percentage of false positives are?
    • No
  • Perry – What is the morbidity rate for children under 14?
    • We can pull that analysis, but I don’t have it on me
  • Perry – Do you show if deaths are vaccine related?
    • There is a database for reports, but the CDC decides if something is vaccine related; we do not track
    • There are a lot of duplicates in the database
  • Perry – It concerns me that there is a push for vaccinations of under 6 months even though the data doesn’t support; if you follow the money to pharmaceutical companies, it makes sense why
  • Perry – Do you have 2021 data for vaccinated and unvaccinated data?
    • It’s not in the presentation but I can get you the data
  • Perry – Is the federal definition of a comorbidity vs a covid death different than the Texas definition?
    • Yes
  • Perry – It is important to distinguish state and federal reporting
  • Hall – Is immunity from the vaccine superior to natural immunity?
    • Yes
  • Hall – How do you explain the fact that people with the vaccine have gotten covid?
    • It’s due to changes in the virus; not the ineffectiveness of the vaccine
  • Hall – How come there was no promotion of monoclonal antibodies?
    • There was more funding for vaccines to fund promotion; there was a very limited supply of monoclonal antibodies
    • We have mobile providers of monoclonal antibodies throughout the state; we offered materials and information on our website
  • Hall – Asks about comorbidity statistics
    • 70 and up were mostly impacted in terms of hospitalizations; comorbidity was across age group
  • Hall – Why should we be pushing questionable vaccine on younger kids?
    • Are ongoing studies that determine safety and efficacy by the federal government; look to them for recommendations
  • Blanco – Asks about information sharing; what data is the state not using?
    • Some things required in federal reporting the state is not using
    • State is not using data including staff shortages and PPE measuring
  • Blanco – Any data you could be reporting?
    • No considerations at this time; challenge for the actual hospital reporting system
    • There are some components on types of emissions and staffing shortages that the state does not use
  • Blanco – Are there any improvements that you all could be reporting?
    • Nothing specifically; talking about trying to streamline the reporting process
  • Perry – Do you think mandatory reporting would be good for tracking adverse reactions to vaccines?
    • Any reporting is helpful, but adverse events are more subjective
  • Hall – How many patients with monoclonal antibody treatment went on to die from Covid?
    • We don’t have specific data on it
    • Hall – Data collection on monoclonal antibody treatment would be very important; need better data collection in the future
  • Kolkhorst – Are you using HHSC for IT data?
    • They are our IT provider
  • Kolkhorst – Are we still in the rulemaking process of SB 969?
    • Yes, electronic pieces should go into effect in January 2023
  • Kolkhorst – It is important to collect data on adverse reactions to vaccines
  • Kolkhorst – In your opinion, how far along are we in data collection?
    • We’ve made a lot of progress; we’ve been able to bring data together that we couldn’t before
  • Kolkhorst – What are the barriers to real-time dissemination of healthcare data? Are we getting closer to having real-time data?
    • During pandemic, established patient transfer system; in 2021, beds were full, and it couldn’t be utilized
    • Challenges for real-time data come from systems’ ability to collect and share data
  • Kolkhorst – Are we updated enough? Do we have the capacity to handle another disaster?
    • Our system in place will be what we need for another pandemic; the hospital reporting side still needs work
    • Currently, hospital data is aggregate data not individual patient data
  • Kolkhorst – Did 25 children die of Covid in 2020 and 58 in 2021? Do we have comorbidities on these children?
    • Yes
    • If comorbidities were reported on the death data, we can get that
  • Perry – So those 58 children in 2021 died of Covid, not comorbidities?
    • Yes
  • Perry – If that child had Covid and diabetes, what would it say on the death certificate?
    • It would probably be Covid as the main cause of death, but diabetes listed as an underlying condition
  • Perry – So would the underlying condition ever be the cause of death?
    • Covid is listed as the cause of death if the doctor believes if it weren’t for Covid, they wouldn’t have died
  • Perry – Are we ever going to have a complete set of data?
    • Death data is required; cases are harder to collect since people can take at home tests
  • Perry – The only data I thought was important to be reported to the public was hospital capacity; most other statistics were a waste of money to report
  • Kolkhorst – What data will the CMS require?
    • It relates to hospitalizations, but it does not include length of stay

 

Nim Kidd, Texas Division of Emergency Management

  • Agency responsible for state preparedness of all state agencies; agencies often prepare in isolation and fail to realize their impact on other organizations
  • Emergency Management Council will continue to discuss and improve state agency response
  • Need to focus on maintaining supply chain
  • Worked to provide emergency equipment, testing, and vaccines; groups of agencies handled together across discipline and jurisdiction
  • Focused on small business owners, elderly population, and military
  • Created maps to help citizens find vaccines and testing sites
  • Money from legislature allowed for state owning warehouses for PPE
  • Requests increased collaboration between agencies for data collection
  • Data systems built from those who built the system; need to bring all partners together
  • Envisions add on to state emergency operations system
  • Hopes to continue to use data for decision making
  • Kolkhorst – How are we doing in reporting hospital bed availability?
    • There is not a unified system for bed reporting; there can be information gaps because of this
    • Not sure that regulatory or legislative push is the way to accomplish this; need to convene doctors and administrators on the ground
  • Kolkhorst – Do we have an IT system that everyone could use if they coordinated?
    • We put a contract in place to help provide that capability; the system that exists today identifies where beds are available regionally not statewide
    • The computer capability is not there for hospital reporting
  • Campbell – There needs to be a system that is easily accessible for all hospitals; Nim Kidd, you can fix this
  • Perry – Hospital capacity is difficult, because it’s rapidly changing; the RAC system worked in my area
  • Perry – Are we dependent on foreign supply chain in Texas?
    • Yes; need to figure out a way to address this
    • There are many economic reasons for outsourcing, but there are Texas made products available just at a higher price
  • Perry – Would it be inappropriate reporting for a RAC to be regional surveying the number of beds and reporting it?
    • No entity can report on their own; reporting needs to come from hospital employees on the ground
  • Perry – Did the RACs coordinate emergency nursing deployment?
    • Yes, but state agencies were mostly responsible for that coordination
  • Blanco – Is there no one unified data collection system?
    • No; not all hospitals use the same resources or use them in the same way
  • Hall – The TDEM team should be in charge; need to focus on information rather than control
  • Hall – Do you have information on monoclonal antibodies?
    • We can get you what we have
    • BCFS is the monoclonal antibody provider; hospitals and clinics did it as well
    • Believes monoclonal antibodies saved his life; in fight with the federal government to get access to monoclonal antibodies
  • Kolkhorst – So are we not receiving monoclonal antibodies from the government?
    • We still get some, but the federal government may stop offering them after a certain date
  • Kolkhorst – Need to stop relying on foreign countries for medical supplies
  • Buckingham – What is the relationship with the federal government like?
    • Federal government decisions don’t always align with the data we’ve provided
    • When the private sector is uninterested or not fast enough, institutions of higher education have stepped up to help the state with emergency response
    • Buckingham – The Biden administration intentionally hurt conservative states and awarded liberal states

 

Dr. Mujeeb Basit, UT Southwestern Medical Center

  • Focus of forecast effort not changed since 2020; helps forecast DFW area
  • Focuses on leveraging local information for decision making
  • Usefulness of data sources fluctuates due to variables such as mobility and hospitalization levels
  • Data collaborations resulted in model of performance
  • Can predict availability of acute care hospital beds
  • Hospital capacity data most accurate of their data
  • Model reviewed frequently by team
  • Test positivity rate data routinely reviewed to identify trends
  • Continued efforts needed to keep model valid
  • Challenging to identify how long immunity is protected
  • Publishes forecast weekly
  • Kolkhorst – What did your data find with regards to morbidity and other variables?
    • We look at hospitalizations rather than morbidity; we don’t have accurate mortality data
  • Kolkhorst – What trends did you find in hospital capacity?
    • At the beginning, most people got admitted; those admitted became more serious as time went on
    • Overtime, length of stay shortened even though patients were more gravely ill
  • Kolkhorst – Have you done modeling on mental health?
    • No, we are focused on Covid hospitalizations
  • Kolkhorst – What do you see with Covid variants?
    • Every infection we see is the variant Omicron; less people are getting hospitalized
    • Texas numbers are higher than they were a month ago, but not worried about exceeding hospital capacity
  • Kolkhorst – Will Covid become like influenza?
    • It probably will progress in similar ways, but it is too early to say we are out of the pandemic
  • Kolkhorst – Why are you seeing a shorter length of stay?
    • A combination of variants becoming less lethal, more people have immunity from vaccinations or previous contraction, and better ability to treat the virus
  • Kolkhorst – Do you keep data on types of vaccinations and hospitalization rates?
    • For forecasting we are not, but we have outcomes analysts who research this
    • It is hard data to draw conclusions because of the different variants and insufficient data collection during the start of the vaccine roll out
  • Kolkhorst – Will we ever get to the point where there is more data available with regards to vaccines?
    • Given enough resources and time, the data can be collected
    • There is a stable global pattern of influenza that helps plan for vaccinations, but Covid has not stabilized
    • Once we reach an endemic phase, we will be able to develop more accurate vaccines for Covid
  • Perry – Do you use other countries and their data for reference?
    • We look at their data to identify new variants
  • Perry – What is your purpose?
    • Forecasting of hospital beds in the DFW area
  • Perry – Is the data extrapolated to other counties?
    • No, we only look at Dallas and Tarrant County
  • Perry – Who is doing it for other cities?
    • UT Houston and UT San Antonio also have efforts
  • Perry – Could this be expanded statewide?
    • Yes, there could be shared data tools that would help other regions forecast
  • Perry – Statistically, could you extrapolate?
    • No
  • Perry – Do you receive state funding for this?
    • No
  • Buckingham – Do you track the accuracy of your forecasts?
    • Yes, we evaluate it regularly
    • We have retrospective correction of our data feeds
  • Buckingham – How accurate are you?
    • We are within 3-5% of our error bands
  • Buckingham – Should people get boosters?
    • It’s not my area of expertise, but there needs to be more data collection here too
  • Hall – Does the data include those with preventative and early treatment vs those who did not that ended up in the hospital?
    • No
  • Hall – What does the model say about people who received certain treatments and whether they survived or died?
    • That is outcomes data, not our data
  • Hall – The federal government incentivized hospitals to give patients treatments that made the problems worse
  • Hall – What other incentives did hospitals receive that dictated what treatments were given?
    • That is not part of our data
  • Hall – Did UT offer monoclonal antibodies?
    • Yes
  • Hall – We need to focus more on outpatient data; you should roll it into your study

 

Panel

Brett Moran, Parkland Health

  • Reviewed statistics and efforts they have worked on
  • Little centralized guidance early on
  • Delays in providing the information impacted ability to address
  • Systems had different practices which impacted the ability to consistently address
  • It is better today, working on streamlining reporting, use of electronic case reporting, etc
  • Federal, state may require differing information
  • Collaborating with local health officials help to create predictive analytic tools which enabled them to reach out to people proactively
  • Encourages continued collaboration including using common terms, etc
  • Need to be able to exchange data in standardized way
  • Recommended standards for data
  • Kolkhorst – how does the legislature help with standards?
    • Believe a lot of strides have been made
    • Provides example of Monkey Pox, no standards in this and each agency is asking for different things
    • Need standards from top down, defers to lawmakers but thinks it should be at state level and hopes clinicians would be involved in it
  • Kolkhorst – contact tracing, is it effective in something like COVID
    • It’s a communicable pathogen, thinks there are benefits to notify so the person can isolate
    • Hopes there was value, and people were able to avoid getting it
  • Kolkhorst – don’t think we contact trace for influenza, speaks about personal responsibility and curious why COVID 19 medicines are rationed versus produced and not available like Tamiflu, why are we behind on this?
    • As COVID becomes more endemic there is not the same need for contact tracing
    • As severity of disease gets less, perhaps tracing not as necessary
    • Agrees with concerns on access to supplies are limited
  • Kolkhorst – echoes concern of lack of access to therapeutics
    • They have data locally, but may not know if someone had monoclonal antibody
    • State has the ability to do this if they want, have areas share information
  • Hall – what did Parkland do to help without patient treatments?
    • Ambulatory visits dove in the first wave, repurposed resources to do telephone outreach to patients
    • Had a limited supply of pulse oximeters, would send patients home with that
  • Hall – what were recommendations for therapeutics to take? A lot of doctors recognized early treatment with existing drugs
    • Following same recommendations that the rest of the country was
    • Literature was being released outside of peer review and valuable information was coming out of evidence based details
  • Hall – asked about financial incentives that dictated treatments?
    • Not aware of any, no stipulations they were aware of
  • Hall – asked about Remdesivir? How did you make decision to continue using it after calls
    • Used leadership and asked them to review best available literature and followed their recommendations
    • Hall – its been reported that there was a financial incentive if Remdesivir and bonuses if COVID was put on the death certificate
    • Did not build anything to “bake that in” but not aware financial incentives
  • Hall – please go back and report back your findings on if financial incentives were used

 

Wanda Helgesen, RACS & Texas EMS Trauma and Acute Care Foundation

  • Systems allowed them to access several data points and information
  • Information about long term health care facilities was difficult to obtain
  • Data in El Paso helped determine certain needs like one of the nation’s first monoclonal infusion center
  • Request to use transfer system like in El Paso
  • Access to timely and accurate data is essential at any time, not just pandemics
    • Provides example of the RAC Data Collaborative

 

Melanie Richburg, TORCH

  • Rural hospital leaders wear many hats, noted all the various roles that employees assumed during the pandemic and data they oversaw
  • Multiple reporting metrics for COVID positive patients – over 20 boxes to consider
  • Clinic supervisor was in charge of reporting testing and mitigation
  • Did get a machine but no one for the machines for 6 months
  • Real need was on the front line and where they allocated resources to
  • Stimulus dollars are gone, trouble with reporting and state and federal forms not matching – would like help to streamline and standardize the process
  • Did regional collaboration well
  • Something must be done about affordable staffing opportunities

 

Katherine Wells, Lubbock Public Health District and TACCHO  

  • COVID significantly strained the public health system
  • Agreements and systems were developed for out of town testers
  • COVID 19 has demonstrated need to modernize public health data and surveillance systems
  • Recommendations were provided via handout: strengthen electronic data that receives disease reports, reporting entities must be required to send timely and accurate information which includes it being complete, public health must be funded for trained staff, electronic case follow up system is needed

 

Panel Q&A

  • Perry – offers appreciation for the individuals on the panels and their work in the area
  • Perry – asked about cost reimbursement, there were different categories of federal dollars but would be interested to know more about cost reimbursement
  • Perry – asked Richburg about the 20 boxes to consider where reporting, what ones were not needed and what should have been there?
  • Perry – asked Wells about fatigue that set in on COVID information, is that good to have that much access and media, thought it watered down the information
    • Did 65 press conferences and there was a lot of information being provided and it did create some COVID fatigue in the community
    • Adjusted messaging to limit number of press conferences they were holding, would stop when numbers went down and then go back when numbers went up
  • Perry – asked about timeliness of data reported out
    • Case count and hospitalizations were 24-48 hrs and death data was coming in from two sources which could have been 24 hrs (hospitals) and a week (death certificates)
  • Perry – thinks this is an opportunity to redirect, reminds panel it is important to put out relevant information and hopes they take that away from the discussions and learn from it
  • Kolkhorst – follows up on El Paso system expansion, how difficult would it be for hospitals to  report to RAC to have some sort of system to know where empty beds are and have some sort of transfer system
    • Helgesen – work will have to be done to get all of entities together for transfer, doesn’t know how that would look but some sort of system that puts out request and ability for the system to respond
    • Helgesen – in their case there was an individual who was monitoring, takes a lot of coordination for transfers to happen
    • Helgesen – Need a lot of groundwork to connect the dots for the systems out there, need to be able to balance a lot of pieces of information and agrees this system is more than about the pandemic (provides example of hemorrhaging pregnant mother in labor)
  • Kolkhorst – asked if they could go through the RAC for this transfer set up
    • Helgesen – depends but it is possible
  • Kolkhorst – perfection is the enemy of the good, challenges members to think this through
  • Kolkhorst – SB 969 was supposed to provide real data and timely
  • Kolkhorst – will be interesting to see where all the funding went to and how do they get better
  • Hall – personnel where hospitals adopted policies were medical staff were leaving because not vaccinated and turning to state for support
  • Kolkhorst – will get to that in a bit, this panel is about the data and has far reaching implications beyond the pandemic
  • Hall – appreciates rural hospitals, would like data on the treatments like what were you doing to keep patients out of the hospitals and what were the results of treatments provided & what was outcome of restricting visiting loved ones in the hospital, etc
    • Richburg – notes getting hands on supply and staff was challenging
  • Blanco – How can the state improve on reporting data to RACs?
    • Helgesen – The use of VEM system works very well
    • Some elements of data hospitals are required to provide are unhelpful, like suspected Covid-19 patients; because there were so many required elements it takes too much effort on the hospital’s part
  • Blanco – How do ensure transfer success in rural communities?
    • Helgesen – Rural communities have developed relationships with the hospitals and medical staff in larger hospitals; it’s very challenging to move them farther
    • We aren’t suggesting that transfer portal is the perfect solution for every patient, but it is a safety valve
  • Buckingham – Some hospitals were completely empty until the surge; had to hire agency nurses and created unnecessary expenses
  • Buckingham – How many beds are normally filled in a hospital without a pandemic?
    • WOMAN IN MIDDLE – We only have 25 beds and usually 5 to 7 are filled; during Covid we had to have a 1:2 nurse to patient ratio and had to hire additional staff
    • Helgesen – There are many elective cases done every day that do not result in a hospitalization, but there is always a chance that a patient coming in for an elective case needs to be hospitalized
    • Moran – At parkland, there isn’t a day that goes by without a code capacity; we are always full
    • Moran – We had to do deferred elective surgeries; the next big strain on hospitals will be on those who had delayed surgeries and appointments
  • Perry – Is there a universal standard for acuity in the transfer portal?
    • There is information in the system to help determine the priority and acuity of patients
  • Perry – Is there one system for the RACs?
    • We have access to a system; effectiveness of using the system varies across the state

 

Examining the impact of state and federal pandemic policies, examining how regulatory guidance impacts the patient-doctor relationship and recommending any changes needed to ensure the development of data-driven guidance during public health emergencies in Texas.

 

Invited Testimony

Kirk Cole, DSHS

  • Covid created a strain on all emergency management resources
  • DSHS responsible for state health under Texas Division of Emergency Management, but all state agencies collaborated
  • Worked with academic partners such as UT School of Public Health; leveraged their expertise for tracking community antibody levels
  • Resource and knowledge scarcity impacted Covid response; DSHS had to modify its role in public health
  • Typical disasters are local or regional, limited in duration, and limited support to effected communities upon request; differed significantly from Covid response
  • Response changed throughout pandemic due to variants, treatment and vaccination development, and federal regulations
  • Covid second leading cause of death in Texas in 2021
  • Cost to DHSH was $10.1 billion; covered by FEMA
  • Covid-19 response unique, but ability to adapt, leverage partnerships, and communicate is not unique to pandemic; will apply lessons learned to the future
  • Kolkhorst – Are we still staffing emergency medical response?
    • No
  • Kolkhorst – Have the need for staffing and the high emergency pay settled down?
    • That is a better question for someone in the workforce; high pay expectations did have large impacts on the system
  • Kolkhorst – How long were emergency medical staff dispatched?
    • From July 2020 to March 2022
  • Kolkhorst – What is local response defined as?
    • Funding for local level activities such as the hospital preparedness program and things purchased that were required at the local level
  • Kolkhorst – What is the difference between local Covid contracts and Covid surveillance?
    • Local contracts were usually with local governments; funding for vaccinations and epidemiology work
    • Covid surveillance was for Covid testing and contact tracing
  • Kolkhorst – Does the state still do contact tracing?
    • It ended in August 2021
  • Kolkhorst – Are you aware of anyone locally doing contact tracing?
    • Local entities may be, but not funded through our budget
  • Hall – How is advice from actual medical professionals weighed against federal advice?
    • We have professional staff in our department that review information; we modified suggestions from time to time to fit with state direction
  • Kolkhorst – Is the DSHS collecting data on the effects of delayed treatments? Do you have data relating to the effects of Covid on mental health?
    • We aren’t examining that data currently; we focus specifically on Covid response
    • There are national studies beginning to examine those issues
  • Kolkhorst – DSHS needs to partner with hospitals to examine the long-lasting effects
  • Hall – Could you give a short list of people with recent clinical experience used for Covid guidance recommendations?
    • Yes, I can provide

 

Panel

Cecile Young, HHSC

  • Communication, coordination, and flexibility are key to working through pandemic

 

Jordan Dixon, HHSC

  • Covid impacted nursing home facilities significantly; 97% of facilities had at least one case amongst residences or staffs
  • 64% of assisted living facilities had at least one case
  • Delta surge had higher severity and deaths; Omicron had more cases but less deaths
  • Long-term care staff depleted; staff had to work without days off
  • 2% decrease in daycare providers since February 2020 due to impact of Covid
  • Kolkhorst – Is there a need for more providers?
    • Yes; it’s both rural and urban
  • Kolkhorst – Requests recommendations before session on how to address issue
  • All CMS certified providers required to follow CDC guidance
  • HHSC tried to implement guidelines where necessary but also flexibility for providers; more rules in place in nursing homes
  • Kolkhorst – Were you required to follow CDC guidelines?
    • We were required to enforce protocols to CMS certified providers; we applied CDC guidance to non-CMS certified providers as well
    • For childcare operations, did not implement many regulations; clinical settings already have strict protocols so did not implement more regulations
    • Tried to add in more flexibility for staffing throughout the medical landscape
  • Relied heavily on partners at TDEM, BCFS, and DSHS
  • Learned the importance of coordination
  • Revised process of incident prioritization
  • Private sector partnerships essential to provide PPE
  • Infection control and mitigation guidance required extensive training; identified nursing home facilities that were struggling and offered training
  • Need a dedicated focus on long-term infection control and mitigation guidance in nursing homes
  • Put 35 emergency rules in place; worked with DSHS to create a comprehensive response plan
  • Learned importance of data collection and reporting; for first two months called every nursing home facility every day
  • Implementing emergency broadcast system to send alerts to facilitators and nursing facility staff
  • Kolkhorst – Do nursing homes not report infection rates?
    • They must report to local health department; reporting was delayed during Covid

 

Scott Schalchin, HHSC

  • All state hospitals and state supporting living had Covid cases; tried to communicate correct information between government and medical providers
  • Closed campuses to essential visitors
  • Covid impacted number of applications for medical staff
  • Provided access to vaccines for staff, patients, and community
  • Focused on acquiring PPE by coordinating with State Operations Center
  • Started screening and testing for visitors and new patients
  • Started testing staff based on community transmission rate
  • Created quarantine and isolation units
  • Essential caregiver bill extremely helpful for patients
  • Currently requires health screenings, wearing PPE, and social distancing for visitors with some exceptions
  • Learned best practices:
    • Restricting off campus outings
    • Establishing relationships early with local health department
    • Hosted vaccine clinics and provided on campus treatment
  • Learned importance of workforce engagement and communication
  • State supported living centers had 37 deaths but over 1,000 recoveries; expected much worse
  • Kolkhorst – No death is acceptable, but these numbers are remarkable; this situation should be used as an example of what to do across the state
  • Staffing ongoing challenge
  • Over 700 beds offline at state hospitals because not enough staff to cover them
  • Kolkhorst – Did you mandate vaccines?
    • No
  • Kolkhorst – Why do you think you are having staffing issues?
    • Boomers leaving the workforce and staff with children during the pandemic
    • Unable to attract staff due to rising salary expectations

 

Panel Q&A

  • Hall – Were the CDC guidelines actually guidelines or requirements?
    • Dickson – Both; the CMS facilities were required to follow them, so we standardized it
  • Hall – So we just blindly follow the federal government without thinking about the patients?
    • Dickson – We are not public health experts; DSHS recommended we follow CDC guidelines
  • Hall – Should we blindly follow the federal government in the future? Without monetary concern, is it really in the best interest of the people of Texas?
    • Dickson – There are some areas that were more restrictive than what we would’ve recommended
  • Hall – Do we know what preventative or early treatment state facilities were doing for patients?
    • Jackson – In state supported living facilities, doctors did whatever their practice allowed them
  • Powell – Is it a common practice for staff with Covid to still care for patients? Is that recommended?
    • Dickson – There was a recommendation at some point to allow asymptotic staff to come into work and care for patients after five days as long as they wore a mask

 

Chris Hilton, Office of the Attorney General

  • At the beginning of pandemic, AG prepared for litigation; way more litigation occurred than expected
  • AG set up disaster counsel at the beginning of pandemic to provide advice to local officials
  • Early litigation touched on all aspects of life such as bar and restaurant closures, masking requirements, and voting restrictions; centered around mitigation efforts
  • Later litigation efforts focus on reopening; both entities reopening before allowed and entities requiring masks after not being allowed
  • Significant federal litigation dealing with vaccine mandates and other issues
  • Mask litigation related to CDC requirements on planes
  • AG involved in Covid-related litigation since beginning of pandemic and remains involved
  • Kolkhorst – Have most of the local disputes been resolved?
    • No, different issues have become more pressing based on the conditions of the pandemic
    • State is more unified than at the beginning of pandemic
  • Kolkhorst – Has the requirement of a vaccine passport been quelled at the litigation level?
    • We have not seen significant legislation with regards to businesses requiring vaccines

 

Dr. Thomas Kim, Texas Medical Association

  • Pandemic still not over; it will take years before we can analyze it as a previous historic event
  • Mental health crisis caused by pandemic
  • Mental distress unlike anything doctors were trained for
  • Goal of healthcare is the prevention of what you can and mitigation of what you can’t
  • Rather than focus on diagnoses and treatments, need to focus on conditions that support healthcare in the long term
  • Recommends codifying regulatory environment supportive of telehealth
  • Requests investing in needs of all Texans; secure access to care reduces cost when facilities are unprepared for a large crisis
  • Kolkhorst – What are the lessons learned in future pandemics and public health crises?
    • I would steer people away from casting blame; more than one thing is happening here
    • My strategies are broad, forward-thinking ways to get people better
  • Kolkhorst – We have all this data, and no one wants to assimilate; can’t just focus on the future
    • One of the commonplace therapeutic processes I say to students is it doesn’t matter who is right or wrong, just matters what you learn
    • The mental health crisis is not new or novel; there are several factors driving this issue
    • Need to have communal agreement to fix the issue rather than identifying certain things as right or wrong
  • Perry – We need to change the paradigm of conversation from this reality as bad; kids are optimistic until they are given a reason not to be
    • Throughout the pandemic, a significant amount of energy has gone toward arguing rather than finding a solution
  • Hall – What are your thoughts on cognitive development when masking children?
    • There is compelling evidence that wearing masks is effective; it is difficult to draw a conclusion that wearing a mask causes trauma in children
    • There were other confounding variables that may be causing cognitive risk amongst young children such as not being able to see family members or parents losing jobs
  • Hall – I’m talking about forcing children to wearing masks for long hours a day and not getting to see people’s faces
    • I support remaining adaptive to the situation at hand; if the situation warrants it, wearing a mask is not a bad thing
  • Hall – What would you need to see to take a position either for or against mandatory masking of children?
    • I am not necessarily able to make a public health recommendation, but I do not think we can blame masks for a mental health crisis

 

Jamie McCarthy, Memorial Hermann Health System

  • Has practiced emergency medicine in Texas for over 20 years
  • Memorial Hermann operates one of the busiest trauma centers and lifeline helicopter centers in the U.S.
  • Since beginning of pandemic, treated over 93,000 patients with Covid; strained resources but never compromised commitment to care
  • Participated in crucial clinical trials
  • In September of 2020, first double lung transplant on Covid victim completed at Memorial Hermann
  • First facility in Houston to administer vaccine
  • Organized first community vaccination event; served as model for rest of country
  • Facilitated vaccination pop-ups throughout Houston
  • Pandemic showed how economic status causes disparity in outcomes; prioritizes equalizing outcomes
  • Perry – What was the protocol for Covid positive patients that were not administered to the hospital?
    • Our protocol changed overtime; we routinely updated to the best possible guidance
    • A patient that didn’t require supplemental oxygen would likely have been sent home early in the pandemic
  • Perry – When did patients receive antibiotic treatments and when did you prohibit it?
    • We never prohibited it, but overtime research has shown that it is largely an ineffective treatment regimen
    • We had a Covid task force to look at clinical data to make guidance
  • Perry – Where doctors prohibited from prescribing off label drugs?
    • We don’t prohibit, but we strongly encourage evidence-based practice
  • Perry – Is there a physician in your network that was terminated for wanting to use off-label medicines?
    • No
  • Perry – Was there ever a conversation that evaluated whether CDC guidance was appropriate? Did you evaluate other countries?
    • We evaluated China’s use of steroids as a Covid treatment as began to use them in certain situations; when research supported the use of steroids we quickly adapted
  • Perry – Did you require your doctors to be vaccinated?
    • Yes
  • Perry – If doctors weren’t vaccinated, were they fired?
    • It was considered a voluntary resignation
  • Perry – Have any of your vaccinated doctors or nurses gotten Covid?
    • Yes
  • Perry – Are you short of workers today?
    • In 2021, we required vaccinations; this decision supported by rapid development of Delta variant
    • Requirement of vaccinations is not new; they protect medically vulnerable patients
    • Senior administrators were required first, then the rest a month later
    • 24 % of employees left due to vaccination requirement
  • Perry – Were exemptions allowed?
    • We allowed for medical exemptions and had a panel that evaluated
  • Perry – What percentage of exemptions were granted?
    • I’m not sure but I can find out
  • Perry – It’s not fair to compare this vaccine to other vaccines such as Polio and TB because it didn’t follow the same protocols
    • I was providing that information for context, not to compare
  • Kolkhorst – Did you receive surge staffing?
    • Yes, they were essential to keep services open during the Delta and Omicron surges
  • Kolkhorst – Did you require surge staff to be vaccinated?
    • Yes
  • Buckingham – Where is the medical logic in requiring a vaccine in individuals that have natural immunity?
    • The initial data on vaccine immunity showed that it was better than natural; research on immunity is still coming out
    • Hybrid of natural and vaccination immunity has shown to be most effective
  • Buckingham – How many people resigned due to the vaccine requirement?
    • There were a lot of threats, but I can get you exact numbers
  • Buckingham – We are getting exposed all the time from asymptomatic individuals; I want to see evidence for mandating a vaccination because the medical community has departed from common sense
    • We can provide the data we looked at to determine the requirement
  • Hall – What is the current mix between vaccinated and unvaccinated patients with Covid?
    • During the Omicron wave, 70% were still unvaccinated
    • I can get you current data
  • Hall – Does Hermann prohibit treating unvaccinated patients?
    • No, in some cases we require testing, but we never refuse patients
  • Hall – Does Memorial Hermann require certain types of treatment?
    • Memorial Hermann does not dictate medical care; the medical staff meets with doctors to determine treatment
  • Hall – Would the hospital take action against a doctor who treated patients with hydroxychloroquine? Would they be terminated? What if they suggested it?
    • No
    • I am not aware of any terminations that occurred due to this
  • Hall – What suggestions did you all give asymptomatic patients?
    • It would depend on underlying conditions
  • Hall – Did you give out monoclonal antibody treatments?
    • Yes
  • Kolkhorst – Why aren’t monoclonal treatments as readily available as suggested by some medical providers?
    • One challenge we had early on was that there was limited supply, so we preserved it for the most vulnerable; we didn’t realize that state allocated monoclonal treatments based on use
  • Kolkhorst – Why can we not get oral therapeutics still?
    • We don’t have trouble getting it; we’ve had better success working with commercial pharmacies
    • Distribution of medicines has evolved; we don’t recommend these medicines to low-risk profiles
  • Kolkhorst – What are your thoughts on a real-time data sharing service?
    • The data would be helpful for critical resources and emergency services
    • In Houston we have emergency department monitoring throughout the city
  • Kolkhorst – Would we ever be able to aggregate and separate data for comorbidities?
    • We could do that in our system, but I’m not sure how other hospitals operate
    • If the patient in our hospital is not receiving Covid-treatment or oxygen but they have Covid, we consider that a secondary diagnosis
  • Kolkhorst – When your data goes to the state, how is it presented?
    • I would need to check with the staff on the way that the data is submitted
  • Kolkhorst – What was the Covid positive add on to Medicare?
    • I can get that from the CFO
  • Kolkhorst – You don’t deny treatment to unvaccinated patients?
    • Unequivocally no
  • Kolkhorst – In February 2022, a children’s hospital denied an organ transplant to an unvaccinated child
    • In the transplant population, they are very prescriptive about medications and vaccinated so they are a specific niche population
  • Kolkhorst – Do you allow childbearing females or males to opt out of vaccines for that reason?
    • We allowed vaccine exemptions for active pregnancies or fertility treatments, but not for those at childbearing ages
  • Kolkhorst – Requests information on how many hospitalized individuals is vaccinated
    • The median age in our ICU has gone up 20 years for Covid patients; it would be interesting to see if it’s because of vaccinations or the variant or other causes
  • Kolkhorst – In the future, will the vaccines change with different strains?
    • Yes
  • Hall – Are you aware of the 70 year old who died in your hospital after not receiving the treatment he requested?
    • The treating physicians did not feel it was the appropriate course of action
  • Hall – Did they really feel it wasn’t appropriate or did they feel that your hospital would fire them? Like with Mary Bowden?
    • We have never taken action against any doctor for using these treatments; we have had conversations with doctors but never fired them
    • Mary Bowden’s privileges were not terminated due to this; she voluntarily resigned due to inactivity in 2019

 

Dr. Robert Malone, Vaccinologist

  • Chief of staff of the previous administration pressured FDA to go around normal processes
  • Has been involved with multiple prior outbreaks, incl. AIDS, smallpox, etc.
  • Have been working on SARS-CoV-2 since receiving a call after the outbreak in Wuhan
  • Prior to COVID, states had the responsibility to respond to disease, role of federal gov was in consultation & advice; was not in place during the COVID pandemic
  • In most cases protocols developed by NIH have been non-transparent
  • Development of vaccine products have been accelerated under pressure from the executive branch of the prior administration; other treats have been blocked or unused under emergency use authorization
  • CDC has played a more supportive role in this outbreak compared to prior incidents
  • According to the NYT, the CDC has become politicized and has actively withheld information & has admitted to failure to not properly reporting data under VAERS
  • Neither patients, physicians, not public health officials have been able to adequately analyze vaccines and public safety
  • Well-documented that money has been spent to market products and suppress other treatments
  • NIH has acted to restrict doctors acting and speaking against federal policy
  • There is evidence in Florida that the gov has restricted access to antibody therapy in retaliation
  • Immunity and effectiveness have been used improperly by NIH and CDC; 30-60% of those in high risk categories are at risk of hospitalization and death
  • Need to define durability of the immunity in terms of effectiveness of response; immunity acquired through infection seems more durable than that acquired by vaccination; majority of those hospitalized with omicron are vaccinated, high risk of re-infection
  • High re-infection rate due to mutation of spike protein, most monoclonal antibodies aren’t working against Delta strain
  • Those infected and vaccinated by S1 are particularly susceptible to mutation in Omicron
  • Individuals with weakened immune system may become chronically infected with Omicron & seems to be contributing to evolution of escape mutants
  • Immune imprinting is important; in study from Britain, those infected from prior infection, then vaccinated, then infected with Omicron are not able to respond to new infection
  • Boosting vaccination with the Wuhan strain could lead this to get worse
  • Have seen weaponization of public health processes, Texas must implement independent state-based monitoring of risk as CDC is not acting in best interests of public
  • Federal gov has usurped right of states to regulate medicine and provide for public health
  • FDA power to regulate does not extend to power of compounding, Texas has right to regulate it’s on food, medicine, and health care
  • Outsourcing biologic and drug manufacturing to India and China represents national security risk
  • Kolkhorst – You laid blame on both administrations which is very fair; opinions on public health are interesting, we’ve spoken extensively about how public health is local; good conversation to think about as we move forward
    • Texas is clearly a medical powerhouse, has developed amazing resources and infrastructure
  • Kolkhorst – Promised we would hear from all angles
  • Perry – There were genuine alternative treatments for COVID before we rushed a vaccine?
    • This is my strong opinion, comes from physicians in TX and elsewhere
  • Perry – February 2020 legislators received a call that this would be dangerous, changed by May 2020; bypassed public health and moved to politics, affected the election in 2020
  • Perry – Was removing immunity from the Emergency Powers Act part of what let pharmaceutical companies access
    • That is one of the factors, Act reinvigorated collapsing vaccine industry in the US
    • Federal contracting mechanism was used that absolved pharmaceutical companies from liability
  • Perry – Should that still be in place or not?
    • Logic for bypassing federal regulations are that they are too burdensome; in my opinion Pfizer exploited that situation
    • Seeing now in counties like Canada where Moderna is shifting liability to the gov, govs ended up being the bag holder
  • Perry – You said you were contacted after outbreak in Wuhan, what was the agenda?
    • The why & how has bedeviled me, cannot account for public health policies as being about public health
    • There is school of thought that this is a crisis exploited for economic benefit, not just for pharmaceutical profits, but economic output from lockdowns, etc.
    • Highlights Great Reset & book of same name that spoke of exploiting outbreak for economic purposes; consistent with plan of small group of individuals for economic benefit
  • Perry – Re-vaccinating doing harm?
    • Data shows we have all been infected or vaccinated, difficult to understand what is happening to small subset that seems to be re-infected with Omicron
    • With Omicron, seems to have evolved to not only escape immunity, but also exploit immunity to re-infect
  • Perry – Are we on a track we need to continue aside from the subset? Can we know?
    • My opinion is there is no medical emergency
    • Cannot anticipate the next waves of evolution, colleague anticipates evolution of more pathogenic form due to the public policies
    • Currently running at about 70% occupancy of beds, no signs of medical crisis currently
  • Kolkhorst – So could it get worse? Endemic?
    • There is some data suggesting that shifting sugar residues could lead to more pathogenic form; no one can predict how things will be 6 months from now
    • We are in an endemic phase much as normal coronaviruses
    • Currently the highly infectious versions aren’t pathogenic, but doesn’t guarantee that next form will not be
  • Perry – Did we do more harm than good?
    • It’s always possible
    • You’re asking retrospectively, case could be made; no way to know if we did because we intervened in the way we did, e.g. vaccinated the control group
    • Overall mortality rate in the US is among the top in the world, mortality rate in emerging economies who have note vaccinated are way down the list
  • Hall – Can’t change anything, we are where we are, future is unknown, but can decide the path; currently on the same path we’re on when this started, which is vaccinate everyone as much as possible
  • Hall – Hearing that we’ve created a problem with those that had prior infection immunity and were vaccinated?
    • This is what the data shows
  • Hall – Highlights great results of therapeutics, could say we’re not accomplishing anything with the vaccine and could move forward with therapeutics
    • In my opinion, 6 months from now we’re going to look back and say this is what we should’ve done
    • New vaccines on Omicron spike are not working, immunologists don’t know how to solve vaccine imprinting
  • Hall – On top of that, push that we have for vaccination, what are your feelings about new effort to vaccinate children?
    • Organization I represent has already put out a position and press conference, no rationale for vaccinating young children, don’t develop severe disease and about 75% have been infected based on serology
  • Hall – Got another report on losing military pilots, not being reported and liable to find ourselves not finding sufficient pilots
    • Pilots know what is going on now
  • Hall – CDC and FDA has low credibility, Texas needs to look at how to handle this problem itself
    • According to the NYT, CDC has been withholding data all the way through the outbreak as it would’ve increased vaccine hesitancy & have become a politicized branch of the government
  • Kolkhorst – On therapeutics, why are we not focusing more on these?
    • DOD encountered resistance from the FDA in moving therapeutics trial forward
    • Kindest explanation is that alternatives would mean emergency use would need to be halted
  • Kolkhorst – 2 vaccines are mRNA, very little talk about J&J
    • Also a gene therapy applied to a traditional vaccination, closest we have is Novavax, but also not entirely traditional
  • Kolkhorst – Why hasn’t Novavax received emergency use?
    • Ran into supply chain and safety problems
    • Many dynamics have to do with conflicts of interest @16:57
  • Kolkhorst – Some people haven’t contracted SARS-CoV-2, who are they and why?
    • Health care workers who are continuously exposed developed a constant low-level IGA response
    • Masks don’t work because they don’t cover your eyes

 

Dr. Eric Boerwinkle, Texas Epidemic Public Health Institute, UT Health School of Public Health

  • Goal of TEPHI is to help Texas prepare for the next public health outbreak & emerge from current outbreak with healthy population and strong economy
  • Provides overview of TEPHI, primary pillar of TEPHI is reserve workforce training program, incl. infectious disease science, pandemic preparedness
  • Training >1k in pandemic preparedness through TEPHI
  • COVID in wastewater predicts prevalence in communities roughly 2 week ahead
  • Goal of TEPHI is proactive, recently added monkey pox to monitoring, also monitoring RSV; intending to go beyond this and monitor all viruses that cause disease
  • Highlights food chain supply, close to disaster during COVID, TEPHI working with large and small ag groups to prepare
  • Worked with DSHS to look at frequency of antibodies against COVID, 98% of Texans have antibodies against spike protein
  • Kolkhorst – Does this include T cell immunity?
    • This is antibody circulation, different aspect of immunity
  • 48% of Texans have antibodies against nucleocapsid protein as a result of relatively recent exposure
  • Good public health and a strong economy go hand-in-hand, launched web series for businesses to share lessons earned during COVID
  • Texas needs accurate and timely data for pandemic preparedness and response
  • Kolkhorst – TEPHI is partnering with health info exchanges on efficacy of vaccines, this is what is really important, heard importance of having data & essentially making a “Texas CDC”
  • Kolkhorst – Don’t think your statute got you there, important to look at aggregation of Texas data due to demographic, geographic, etc. differences; CDC under Trump or Biden has tremendous pressure, not sure others are making great decisions for Texas
    • Agrees, working hard to realize that
    • Pushing back against Texas CDC label, don’t want to be branded the same as something that hasn’t been looked up to recently; CDC hasn’t done a good job with spreading & sharing info
    • Some things TEPHI is doing aren’t CDC recommendations, e.g. monitoring monkey pox
    • Will need to look at statute to allow DSHS to share info with TEPHI
    • Need to gather data, but also need to turn it into information & knowledge, then work with others on policy
  • Buckingham – What is a spline?
    • Spline is a way of smoothing a line
  • Buckingham and Boerwinkle discuss graph measuring level of COVID virus in wastewater, tracks and leads number of inpatients at Texas Medical Center by about 2-4 weeks
  • Buckingham – You said we were about to have a bad situation until something happened?
    • No
  • Kolkhorst – Might have been a different witness
    • Might have been testimony about the danger during COVID due to food chain supply, especially in North Texas where workers were co-located in dorms; TEPHI has been working with food producers
  • Buckingham – That was because workers were getting sick or the animals?
    • With COVID it was the workers

 

Chris Palazola, Texas Medical Board

  • Speaking on TMB pandemic response, TMB waivers, executive orders, and COVID complaints
  • Provides overview of TMB reaction after Gov executive orders, incl. waivers, increasing numbers of providers, expanding telemedicine, etc.
  • Highlights timeline of executive orders affecting TMB and disposition
  • Received over 1,800 COVID complaints, vast majority dismissed outright or resolved with warning letter, less than 250 resulted in investigation, 3 resulted in disciplinary order; no licensee has been suspended, restricted, or revoked due to COVID complaint
  • Highlights TMB COVID response website
  • Hall – Seemed like TMB took on the role of defining standard of care and used that to investigate a number of doctors
    • TMB does not determine standard of care, complaints involving quality of care issues; initially review and get response from licensee, then referred to expert panel who advises on standard of care
  • Hall – Little different than answers I’ve gotten from doctors receiving inquiries; you have authority to do admin dismissal and got rid of anonymous complaints, but you still had some second, third, or fourth hand complaints; you had complaints where you couldn’t verify the patient, how does that get past admin dismissal
    • Normally have patient name and DOB associated, can come from family member, subsequent treater, pharmacist, etc.
  • Hall – Why would you not dismiss something you couldn’t confirm? Why would you take a complaint stemming form a Facebook quote?
    • Wouldn’t take a complaint from Facebook
  • Hall – One complainer picked up a complaint from Facebook
    • Currently no restriction on who can file a complaint, field complaints related to licensees that we have jurisdiction to regulate
  • Hall – Asking why you would run with a complaint stemming from a Facebook post, or a complaint about a patient wanting the same treatment someone else has received and doctor takes revenge?
    • If TMB gets a complaint, it will not initially be reviewed by a physician, typically send it forward at least one step to complaint reviewers who are physicians and they have authority to dismiss, can also send initial letter to licensee and give an opportunity to respond
    • Once the licensee responds can then again dismiss
  • Hall – From what I’m hearing there was a bias on complaints involving HCQ and ivermectin and TMB moved forward even though it would cost doctors $10k, $25k
    • Hasn’t been intention of the TMB to treat COVID complaint differently, not aware of a bias & have tried to treat these complaints the same as others
    • If complaints involve Facebook posts are typically quickly dismissed, have received several as you described but they didn’t go further than review and dismissal
  • Hall – Think you’ll hear from doctors that don’t feel the same way; had a meeting last year about TMB spending time harassing doctors with no patient harm, response we received was that doctors broke TMB rules; this concerned me, rules probably not even properly issued
    • Wouldn’t characterize it that way and not familiar with hat response
    • Certainly wouldn’t prioritize rules over patient harm, there are complaints we receive that don’t involve obvious patient harm, but can be relative, e.g. depending on financial situation can be harmful, delay in medical records leads to delay in care, etc.
    • Wouldn’t be something we take severe disciplinary action, but wouldn’t necessarily be no patient harm
  • Hall – Off-label use of drugs is fairly standard, correct?
    • Yes
  • Hall – But TMB issued letters to doctors for off-label use of HCQ and ivermectin because they didn’t get informed consent, is informed consent required?
    • If something involves informed consent, would rely on experts to delineate
    • The Rule does have guidelines for the prescribing of off-label medication, there is a documentation requirement that physician had a conversation with patient, medication is approved, had clinical trials, safe for humans, benefits, etc.
  • Hall – So you don’t require informed consent for every use off-label, just for COVID?
    • Rule 200 doesn’t apply just to COVID, applies to any medication
  • Hall – That’s not what the chair’s letter said, said they have to have informed consent; was this because it was drugs used for COVID?
    • Would refer out to expert physicians, as I understand it informed consent is part of all diagnosis, treatment, and prescribing whether for COVID or anything else
    • Patient always makes the decision
  • Hall – So doctors suggesting aspirin for heart problems would need informed consent?
    • Can be a moving target, something being prescribed routinely, with reasonable and prudent physician standard, circumstances, etc.
    • Would refer this out to physician, could predict what expert opinion on aspirin for a heart condition would be, but as a non-physician wouldn’t be right person to answer definitively
  • Hall – Complaint system is a closed system, many states have an open system where people have right to know who made complaint and everything is public
    • That’s the statute, 164 of the Medical Practices Act says complainant can be confidential
  • Kolkhorst – Complaints can come in anonymously from other states?
    • Careful with anonymous and confidential, can’t accept anonymous complaints, these are non-jurisdictional and we can’t review
    • If they want to maintain confidentiality, we do accept those; focused on whether complaint could be violation of statute
  • Kolkhorst – So someone could just target a doctor and come up with a complaint and then the doctor has to go through hoops to dismiss & it’s pretty difficult
    • Would hope staff would weed complaints out, would follow up and ask for details, if details result from Facebook, etc., then those types are dismissed
    • If complaints are valid or if true would be valid, typically follow up
  • Buckingham – There are doctors that are using off-label with preponderance of evidence that treatments are effective, but may not be standard of care; should take physicians using innovative treatments into account
  • Buckingham – Complaints need to be connected to patient treated by the physician, records typically reviewed by a physician in the same specialty
  • Hall – Only have a finite amount of time and money to spend, concerned about how we’re spending it and effective; highlights times when TMB has not taken action on deaths, opioids, other allegations
  • Hall – Don’t know why we would proceed with investigations where we don’t at least confirm a patient exists or saw the doctor
    • Initial opportunity for physician to respond is before investigations, in situations where patient is fictitious or didn’t see the doctors, should be dismissed before opening investigation
    • Do understand stress in responding to initial letter and possibility of hiring attorneys before drafting response, etc.
    • For other complaints, try to enforce all statutes and rules equally
  • Hall – Sounds like we need some legislation changes

 

Timothy Tucker, Texas State Board of Pharmacy

  • Worked with Office of the Gov to temporarily suspend rules impacting patient care, worked on communication to conduct business and inform public, expedited licensing, etc.
  • Complaint totals over pandemic, but very few were directly related to COVID; annual data shows calls trended down, TSBP attributes this to enhanced communications
  • Worked with agencies like TMB to issue statements on prescribed drugs and treatments
  • Looked to HHSC data, large number of those vaccinated received vaccines in pharmacies, pharmacies also provided testing
  • Perry – Does TSBP have jurisdiction overt independents and national?
    • All pharmacies, pharmacists, and technicians
  • Perry – Do you have requirements for staffing of those? E.g. can’t keeping pharmacy over the weekend
    • Pharmacist may not be open without pharmacist with license there
  • Perry – Has caused a problem, some have closed doors over weekends; should need pharmacies to have a triage plan for off hours
  • Perry – Not sure I agree with the idea that a pharmacist has to be on site, drugs were prescribed by doctors, drugs sitting on the shelf and could be handled
  • Buckingham – Passed a bill allowing pharmacists to overrule physician based on conscientious objection, correct?
    • Pharmacists job to use professional discretion to visit with patient or physician
  • Buckingham – Are we the only state that allows pharmacist to override physician for any medication at any time of their choosing?
    • Not sure of the bill you’re talking about
  • Buckingham – Guessing we’re the only state; when pharmacist objects to ivermectin being prescribed, that just doesn’t happen
    • Pharmacists would typically reach out to provider, but pharmacists can say yes or no
  • Buckingham – What is the appeals process?
    • Would hope provider reaches out to pharmacist first
  • Buckingham – TSBP shutting down pharmacies that don’t dispense ivermectin or others
    • TSBP is not prohibiting and not saying to do it
  • Buckingham – Have received lots of complaints from pharmacies, perception that TSBP will shut them down if they prescribe, why do you think this exists?
    • Not sure, many pharmacists are filling those because I’ve heard about it on a regular basis; TSBP has been clear it does not have a policy and pharmacist makes the decision
    • People get very upset when they can’t get it, encourage patients to find pharmacies that will fill these
  • Buckingham – Have had significant difficulty finding any pharmacy in the state that will fill these, worth a second look; bill was based on morning after pill, which I support
  • Perry – I think there ought to be huge liability for pharmacists overriding doctor’s prescription; thinks TSBP should put staffing issue on agenda, will be proposing legislation in 2023
    • Will visit with you on this
  • Hall – TSBP sent a letter to pharmacies instructing them not to fill HCQ
    • Learned a lesson from that and it will not happen again

 

Dr. Peter McCullough, Internist & Cardiologist

  • There has always been a duty to treat COVID, if a doctor did not treat, there was a duty to refer
  • Standard of care evolves over time, early in the pandemic certain drugs became standard of care which became standard of care as indicated by usage
  • Little data on early treatment outcomes, should have early treatment statistics next pandemic
  • Trials and studies indicate that multi-drug therapy treating symptoms is the approach to handle COVID
  • Should pay attention to large events, early federal hearing established effectiveness of steroids, should have been the standard of care; should pay attention to guidelines for care
  • When WHO recommended ceasing use of remdesivir, committee should’ve asked which providers were using it and investigated
  • COVID vaccines went through 2 months of observations, standard is 24 months for typical vaccines, new mRNA vaccines needed 5 years
  • Pfizer knew about >2k deaths shortly within release of the vaccine, no one did anything; FDA agree that vaccines cause damage
  • VAERS confirms 13k have died with the vaccine; more probable than not that vaccines are causing deaths; World Council for Health has called for recall of vaccines
  • Omicron infects more vaccinated people than unvaccinated people
  • Kolkhorst – Is Congress doing anything about the global recall?
    • No governmental body has reacted to the call for recall, failure of government
  • Seeing large amounts of censorship and reprisal, deaths after vaccines are censored
  • Need to have a conversations about the risks and benefits of the vaccines, should create work group on censorship and reprisal
  • Patients have a right to take medications they want to, HCQ and ivermectin are in guidelines in many other parts of the world, doctors should not impose their own decisions
  • Perry – Need someone at the state level watching, lack of transparency has led to rise in public distrust; do you have any observation of money in the process of vaccines/
    • Have heard the word “evil” circulated for the first time; from the beginning of the pandemic, many worldwide were doing harm; examples are endless and inexplicable
  • Perry – Sign of the times
  • Kolkhorst – We heed your warnings

 

Public Testimony

Dr. Richard Bartlett, Self

  • Have seen experts issuing mandates with no science to back the decrees
  • Promoted use of budesonide and saw positive outcomes, trails confirmed that it would’ve prevented hospitalization; video on budesonide was censored because it interfered with emergency use authorization for vaccines
  • Censorship was extensive, Indian news networks discredited use of budesonide
  • Dangerous things were done during pandemic with little or no oversight, highlights Odessa hospital putting equipment covers over patients
  • Pfizer was sued to release adverse events, released 1/4th of required information and saw 1,200 of bad outcomes
  • Antibody infusion centers were something done right
  • Need to insist on informed consent, monkey pox vaccines have been bought by the federal government
  • Perry – Budesonide was an inhaler?
    • Can be, also comes in an inhaler
  • Hall and Bartlett discuss effectiveness of budesonide, hundreds of thousands treated successfully
  • Hall – You’ve been harassed by TMB?
    • Received 3 letters, one was about use of the words “silver bullet,” treatment decisions of others who were informed about budesonide
  • Kolkhorst – Therapeutics were where we really missed the boat
    • Early treatment saves lives

 

Dr. Brian Proctor, Self

  • Received 10 complaints, many due to COVID; patient prescribed ivermectin posted to Facebook, received complaint after for not following informed consent process
  • Cigna filed complaint for prescribing controlled substances and ivermectin complaint; received CME & sanctioned by Cigna
  • Kolkhorst – Did Cigna file the complaint with TMB?
    • Cigna filed the complaint with TMB, in dismissal letter from Cigna they cited HCQ

 

Dr. Amy Offutt, Self

  • Should never abandon patients, have treated 4,100 COVID patients with 74 hospitalizations and 10 deaths, never turned away a patient

 

Dr. Shelley Cole, Self

  • Recently was under investigation by the TMB; many asserting that there are no therapeutic treatments for COVID
  • TMB alleged sale of fake vaccine cards, had to turn over medical records uninvolved medical records
  • Kolkhorst – Is your case still open?
    • Has been dismissed
  • Kolkhorst – You weren’t selling fake vaccine cards?
    • No

 

Dr. Stella Immanuel, Self

  • Familiar with HCQ use in West Africa, comfortable using it to treat COVID after being informed it was working; HCQ was very effective
  • Have had over 30 TMB complaints

 

Eric Epley, Southwest Texas RAC

  • Speaking on data collection, data silos are frustrating and inefficient; need consolidated structure to collect data
  • Platforms exist to allow collection to be more effective
  • Kolkhorst and Epley discuss difficulties with data collection and patient stranding
  • Kolkhorst – Look forward to working with you on the next iteration of 969

 

Dr. David Weisoly, TETAF

  • Infant and maternal care has likely improved since implementation of levels of care rules, but no empirical data to show this
  • Critical need of qualitative measures data, have an opportunity to build on statewide RAC perinatal data collaborative
  • Kolkhorst – Can’t even get data on vaccinations, need granular data

 

Michael Gratch, Flow Therapy

  • Long COVID is impacting large numbers of Texas, much more than a respiratory issue
  • Flow Therapy provides noninvasive therapy for chest pain and vascular therapy, able to assist in treating long COVID

 

Dr. Eric Hensen, Self

  • Gov Abbott’s mask mandate was ill-advised and Gov Abbott was helped by friends in the TMB to implement
  • Highlights several complaints filed through the TMB against him, had to go through a remedial plan on complaint related to not wearing masks
  • Hall – This is what I was referring to when I spoke about TMB caring more about rules; need to look at time wasted on trivia associated with COVID

 

Jessica Boston, Texas Association of Home Care & Hospice

  • Home Care has been largely left out of pandemic planning and response
  • Guidance was inconsistent between federal and state authorities, should have a work group with stakeholders
  • Asking for regulatory relief for providers struggling to maintain their workforce
  • Asking for home health to be included on pandemic planning

 

Dr. Mark Ogden, Self

  • Works with a freestanding ER, have heard positive comments from patients who appreciate services through freestanding ERs; freestanding ERs are cheaper, have an important place in pandemic preparedness and response
  • Kolkhorst – Are you still under the Medicare waiver?
    • Will renew in July
  • Kolkhorst – You receive Medicaid as well?
    • Will need to verify

 

Dr. Angie Farella, Self

  • Has been targeted and shadow banned on social media, targeted by TMB, highlights complaint resulting from transfer of pediatric patient

 

Jana Radwansk, Self

  • Studies showing lack of effectiveness with therapeutics have been discredited, not transparent; statistics related to vaccines and deaths are being misreported

 

Christine Welborn, Texans for Vaccine Choice

  • 1.3m reports of adverse events following COVID jabs, many were forced to take vaccine against their will
  • Executive overreach led to economic calamity, need to protect free market principles, need to protect informed consent

 

Helen Erikson, Self

  • Resigned from Memorial Hermann hospital after vaccination drive
  • Observed patients that had adverse reactions, many report family member fatalities

 

Cyndie Phillips, Self

  • Distributes copies of the Omega Brief alleging collusion and crimes against humanity between CDC, NIH, vaccine manufacturers, others

 

Sarah Lindley Bailey, Self

  • Quotes individual from EcoHealth Alliances pushing for increasing support for medical countermeasures like pan-coronavirus vaccines

 

Catherine May, Self

  • Moderna had a vaccine for coronavirus before COVID, part of plan for crowd control

 

Deborah Farris, Self

  • Cites Omega Brief about plan to inject people with harmful spike protein

 

Sharon DeMarsais, Self

  • Not vaccinated, got mild case of COVID; highlights friend who grew critically ill after vaccine

 

Tina Orebaugh, Self

  • 1.3m adverse reactions VAERS; children get 23 vaccines before they’re 18, related to autism

 

Tami Carroll, Self

  • Daughter was hospitalized early in the pandemic due to kidney failure, access was restricted
  • Spoke with Dr. Fauci’s wife who said funding would not be provided for artificial kidneys until after everyone was vaccinated

 

Travis Fell, Self

  • Cites case of teenager who was denied transplant due to lack of vaccination

 

Kenya Alu, Self

  • COVID pandemic led to dad being refused proper care, TMB did not assist; widespread issue that affected multiple families
  • Kolkhorst – Passed SB 25 and constitutional amendment last session, working to fix this

 

Fran Rhodes, True Texas Project

  • COVID protocol and guidelines were damaging, legislature should be involved in emergency orders lasting longer than 30 days

 

Claudine Nicholas, Self

  • Censorship narrowed access to COVID treatments, government is exerting undue influence on medical profession

 

Sandy Bittrick, Self

  • Lockdown generated a lot of fear, grandson grew depressed and led to death by suicide

 

Sheila Hemphill, Texas Right to Know

  • Ozone therapy in Italy saw great success, info on alternative treatments was suppressed in order to secure emergency use authorization for the vaccine
  • COVID is a bioweapon, spike protein can infiltrate cells and cause immune system to target the body’s tissues
  • Texas needs a medical professional to protect it from the WHO, NIH, CDC, etc.

 

Sheena Rodriguez, Latinos for America First

  • Response to COVID will continue to have long-lasting impacts for years
  • State continues to allow vaccine mandates, school shutdowns led to cognitive and educational deficiencies, child & teen suicides have skyrocketed

 

William Carlile, Self

  • Losing faith in the medical system, got COVID and used therapeutics, got better within 2 days

 

Dr. Steve Montoya, Self

  • Against corporate practice of medicine; got COVID and took fluids at home, treatment would’ve been poor at hospital
  • Kolkhorst – Why were you going into kidney failure?
    • Side effect of COVID
  • Kolkhorst – How did you prevent it?
    • Fluids
  • Kolkhorst – What would’ve been the standard of care at the hospital?
    • All the medications that have been talked about would’ve been used

 

Matt Long, Fredericksburg Tea Party

  • Response from the government seemed to be worse than COVID
  • Need to limit Governor’s emergency powers to a certain point in time
  • Freedom to speak and gather were discarded during the pandemic

 

Margie Barilla, Elevate Healthcare

  • Highlights challenges with appeals to insurance companies, difficult to have access to proper PPE equipment in competition with larger entities

 

Angela Smith, Fredericksburg Tea Party

  • TMB was allowed to terrorize doctors and decimate the doctor-patient relationship
  • Government regulations, agencies, and policies adversely affected outcomes
  • Real concern is lack of special session and renewal of the disaster declaration

 

Carolyn Carlile, Self

  • Children should not be masked, religion releases fear and masks are unnecessary